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General NPI Number Information
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NPI Number | 1124064654
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Entity Type | Organization
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Legal Business Name | SAN TAN EYECARE - PARADISE VALLEY, PLLC
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Dates
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Enumeration Date | 06/22/2006
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Last Update Date | 07/31/2024
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Provider Practice Location Address
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Address Line | 4550 E BELL RD STE 104
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City | PHOENIX
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State | AZ
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Zip | 85032-9342
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Country | US
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Telephone | 602-661-6519
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Fax | 602-996-4231
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Provider Business Mailing Address
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Address Line | 4550 E BELL RD STE 104
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City | PHOENIX
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State | AZ
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Zip | 85032-9342
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Country | US
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Telephone | 602-661-6519
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Fax | 602-996-4231
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Authorized Official
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Title or Position | MANAGER
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Name | JOHN N CHRISAGIS
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Credential | OD
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Telephone | 480-967-4910
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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