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General NPI Number Information
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NPI Number | 1205590247
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Entity Type | Organization
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Legal Business Name | THE EYE DOCTOR PLLC
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Dates
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Enumeration Date | 10/26/2021
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Last Update Date | 10/26/2021
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Provider Practice Location Address
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Address Line | 12419 N TATUM BLVD # A111
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City | PHOENIX
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State | AZ
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Zip | 85032-7708
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Country | US
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Telephone | 559-472-8209
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Fax |
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Provider Business Mailing Address
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Address Line | 907 N 85TH ST
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City | SCOTTSDALE
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State | AZ
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Zip | 85257-4564
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Country | US
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Telephone | 559-472-8209
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | JENNIFER CHAU
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Credential | OD
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Telephone | 559-472-8209
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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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