Healthcare Provider Details

I. General information

NPI: 1649271164
Provider Name (Legal Business Name): EUGENE SHIFRIN OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10619 N HAYDEN RD STE 101A
SCOTTSDALE AZ
85260-8510
US

IV. Provider business mailing address

14269 N 87TH ST STE 203
SCOTTSDALE AZ
85260-3695
US

V. Phone/Fax

Practice location:
  • Phone: 480-798-0733
  • Fax: 480-563-1413
Mailing address:
  • Phone: 480-483-8882
  • Fax: 623-563-1413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1563
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: