Healthcare Provider Details

I. General information

NPI: 1538496294
Provider Name (Legal Business Name): BRICELAND ENTERPRISES PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2009
Last Update Date: 11/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13624 W CAMINO DEL SOL STE 200
SUN CITY WEST AZ
85375-3401
US

IV. Provider business mailing address

13624 W CAMINO DEL SOL STE 200
SUN CITY WEST AZ
85375-3401
US

V. Phone/Fax

Practice location:
  • Phone: 623-546-2020
  • Fax: 623-546-2399
Mailing address:
  • Phone: 623-546-2020
  • Fax: 623-546-2399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number19009
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code156FX1100X
TaxonomyOphthalmic Technician/Technologist
License Number18851
License Number StateAZ

VIII. Authorized Official

Name: DANIEL J BRICELAND
Title or Position: OWNER/PHYSICIAN
Credential: M.D.
Phone: 623-546-2020