Healthcare Provider Details

I. General information

NPI: 1578806881
Provider Name (Legal Business Name): PLESSEN EYE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2013
Last Update Date: 04/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9001 ESTATE VISTA CONCORDIA
CHRISTIANSTED VI
00820-5655
US

IV. Provider business mailing address

PO BOX 8677
CHRISTIANSTED VI
00823-8677
US

V. Phone/Fax

Practice location:
  • Phone: 602-885-3917
  • Fax:
Mailing address:
  • Phone: 602-885-3917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JAN BIJAN TAWAKOL
Title or Position: CEO
Credential: M.D.
Phone: 602-885-3917