Healthcare Provider Details

I. General information

NPI: 1710707716
Provider Name (Legal Business Name): EYE FORS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2024
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16968 W BELL RD STE 402
SURPRISE AZ
85374-8943
US

IV. Provider business mailing address

16968 W BELL RD STE 402
SURPRISE AZ
85374-8943
US

V. Phone/Fax

Practice location:
  • Phone: 623-214-0353
  • Fax: 623-214-0693
Mailing address:
  • Phone: 623-214-0353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. INGA LILLIANA FORS
Title or Position: OD/ OWNER
Credential: OD
Phone: 623-214-0353