Healthcare Provider Details

I. General information

NPI: 1548465248
Provider Name (Legal Business Name): ARIZONA OCULAR PROSTHETICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 07/17/2020
Certification Date: 07/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3025 S KENNETH PL
TEMPE AZ
85282-3942
US

IV. Provider business mailing address

3025 S KENNETH PL
TEMPE AZ
85282-3942
US

V. Phone/Fax

Practice location:
  • Phone: 480-264-3041
  • Fax:
Mailing address:
  • Phone: 480-264-3041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1700X
TaxonomyOcularist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: ROBERT J BROWN
Title or Position: PRES/OCULARIST
Credential: BCO
Phone: 480-264-3041