Healthcare Provider Details

I. General information

NPI: 1780902320
Provider Name (Legal Business Name): STAR PUPIL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2010
Last Update Date: 05/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20201 N SCOTTSDALE HEALTHCARE DR #150
SCOTTSDALE AZ
85255-4134
US

IV. Provider business mailing address

20201 N SCOTTSDALE HEALTHCARE DR #150
SCOTTSDALE AZ
85255-4134
US

V. Phone/Fax

Practice location:
  • Phone: 480-433-7185
  • Fax: 480-513-6923
Mailing address:
  • Phone: 480-433-7185
  • Fax: 480-513-6923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1100X
TaxonomyOphthalmic Technician/Technologist
License NumberAZ21532
License Number StateAZ

VIII. Authorized Official

Name: MR. JAMES L PLOTNIK
Title or Position: OWNER
Credential: M.D.
Phone: 480-433-7185