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General NPI Number Information
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NPI Number | 1184769028
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Entity Type | Organization
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Legal Business Name | AFFILIATED OPHTHALMIC SVC
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 11/19/2007
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Provider Practice Location Address
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Address Line | 500 W THOMAS RD SUITE #250
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City | PHOENIX
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State | AZ
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Zip | 85013-4224
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Country | US
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Telephone | 602-263-9345
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Fax |
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Provider Business Mailing Address
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Address Line | 3500 E LINCOLN DR # 30
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City | PHOENIX
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State | AZ
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Zip | 85018-1010
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Country | US
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Telephone | 602-955-5104
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. E FREDRICK BLOEMKER
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Credential | MD
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Telephone | 602-955-5104
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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 |
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License Number State |
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