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General NPI Number Information
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NPI Number | 1295938207
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Entity Type | Organization
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Legal Business Name | FORNARA EYE CENTER P.C.
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 11/10/2009
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Provider Practice Location Address
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Address Line | 199 S CANDY LN 2A
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City | COTTONWOOD
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State | AZ
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Zip | 86326-4183
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Country | US
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Telephone | 928-634-2883
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Fax | 928-634-0110
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Provider Business Mailing Address
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Address Line | 199 S. CANDY LN 2A
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City | COTTONWOOD
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State | AZ
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Zip | 86326
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Country | US
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Telephone | 928-634-2883
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Fax | 928-634-0110
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Authorized Official
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Title or Position | SECRETARY
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Name | KIM K FORNARA
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Credential |
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Telephone | 928-634-2883
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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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