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General NPI Number Information
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NPI Number | 1003141771
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Entity Type | Organization
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Legal Business Name | PHOENIX RETINA CENTER, LLC
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Dates
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Enumeration Date | 10/13/2009
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Last Update Date | 10/21/2010
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Provider Practice Location Address
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Address Line | 5410 N SCOTTSDALE RD SUITE A400
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City | PARADISE VALLEY
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State | AZ
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Zip | 85253-5927
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Country | US
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Telephone | 480-278-8980
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Fax |
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Provider Business Mailing Address
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Address Line | 5410 N SCOTTSDALE RD SUITE A400
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City | PARADISE VALLEY
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State | AZ
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Zip | 85253-5927
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Country | US
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Telephone | 480-278-8980
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. INGEBORG E KIRCH
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Credential | MD
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Telephone | 480-278-8980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 37088
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License Number State | AZ
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