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General NPI Number Information
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NPI Number | 1255519054
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Entity Type | Organization
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Legal Business Name | OASIS EYECARE PLLC
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Dates
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Enumeration Date | 02/04/2008
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Last Update Date | 01/08/2009
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Provider Practice Location Address
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Address Line | 1444 S SOSSAMAN RD
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City | MESA
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State | AZ
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Zip | 85209-3400
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Country | US
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Telephone | 480-333-6563
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Fax | 480-333-6564
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Provider Business Mailing Address
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Address Line | 532 S VISALIA
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City | MESA
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State | AZ
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Zip | 85202-1721
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | ALICIA S MCCALLEN
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Credential | OD
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Telephone | 480-474-4584
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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 | 1462
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License Number State | AZ
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