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General NPI Number Information
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NPI Number | 1316368509
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Entity Type | Organization
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Legal Business Name | DSH OD, LLC
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Dates
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Enumeration Date | 12/15/2013
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Last Update Date | 12/15/2013
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Provider Practice Location Address
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Address Line | 114 W CAMELBACK RD STE 1
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City | PHOENIX
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State | AZ
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Zip | 85013-2563
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Country | US
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Telephone | 602-264-4104
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Fax |
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Provider Business Mailing Address
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Address Line | 114 W CAMELBACK RD STE 1
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City | PHOENIX
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State | AZ
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Zip | 85013-2563
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Country | US
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Telephone | 602-264-4104
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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. DAWN SPIRK HEFFELFINGER
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Credential | O.D.
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Telephone | 602-264-4104
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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 | 1108
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License Number State | AZ
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