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General NPI Number Information
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NPI Number | 1285200022
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Entity Type | Organization
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Legal Business Name | OPTOMETRIC CONSULTING SERVICES, INC
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Dates
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Enumeration Date | 06/02/2021
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Last Update Date | 06/02/2021
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Provider Practice Location Address
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Address Line | 2750 S PACIFIC AVE STE D
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City | YUMA
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State | AZ
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Zip | 85365-3547
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Country | US
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Telephone | 928-580-6356
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Fax |
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Provider Business Mailing Address
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Address Line | 2750 S PACIFIC AVE STE D
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City | YUMA
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State | AZ
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Zip | 85365-3547
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Country | US
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Telephone | 928-580-6356
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Fax | 928-783-8445
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Authorized Official
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Title or Position | PRESIDENT
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Name | TOM DETERMAN
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Credential | OD
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Telephone | 928-580-6356
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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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