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General NPI Number Information
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NPI Number | 1366803538
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Entity Type | Organization
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Legal Business Name | OCULOPLASTIC EYE SURGEONS OF PHOENIX
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Dates
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Enumeration Date | 03/15/2016
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Last Update Date | 03/15/2016
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Provider Practice Location Address
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Address Line | 3811 E BELL RD SUITE 106
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City | PHOENIX
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State | AZ
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Zip | 85032-2138
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Country | US
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Telephone | 480-788-1134
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Fax |
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Provider Business Mailing Address
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Address Line | 22320 N 59TH LN
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City | GLENDALE
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State | AZ
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Zip | 85310-4264
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Country | US
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Telephone | 480-788-1134
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LISA D MIHORA
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Credential | M.D.
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Telephone | 480-788-1134
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 44635
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License Number State | AZ
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