Healthcare Provider Details

I. General information

NPI: 1215619283
Provider Name (Legal Business Name): MARKETPLACE OPTICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2023
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1495 E TUCSON MARKETPLACE BLVD STE 161
TUCSON AZ
85713-0047
US

IV. Provider business mailing address

1495 E. TUCSON MARKETPLACE BLVD STE 161
TUCSON AZ
85713-0047
US

V. Phone/Fax

Practice location:
  • Phone: 520-221-4373
  • Fax: 520-200-5769
Mailing address:
  • Phone: 480-980-3873
  • Fax: 520-200-5769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. ARJUN PATEL
Title or Position: SOLE MEMBER
Credential: OD
Phone: 480-980-3873