Healthcare Provider Details

I. General information

NPI: 1104897842
Provider Name (Legal Business Name): ADOBE EYECARE CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 05/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2340 W 24TH ST
YUMA AZ
85364
US

IV. Provider business mailing address

2340 W 24TH ST
YUMA AZ
85364
US

V. Phone/Fax

Practice location:
  • Phone: 928-329-9685
  • Fax: 928-329-9678
Mailing address:
  • Phone: 928-329-9685
  • Fax: 928-329-9678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD818
License Number StateAZ

VIII. Authorized Official

Name: DR. JILL CAPORELLI
Title or Position: OWNER / OPTOMETRIST
Credential: OD
Phone: 928-329-9685