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General NPI Number Information
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NPI Number | 1376871079
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Entity Type | Organization
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Legal Business Name | ARIZONA CONTACT LENS CONSULTANTS PLLC
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Dates
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Enumeration Date | 11/18/2009
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Last Update Date | 11/18/2009
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Provider Practice Location Address
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Address Line | 5401 S WHITE MOUNTAIN RD
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City | SHOW LOW
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State | AZ
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Zip | 85901-7849
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Country | US
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Telephone | 928-532-1547
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Fax | 928-532-1549
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Provider Business Mailing Address
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Address Line | 1071 E PINE OAKS DR
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City | SHOW LOW
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State | AZ
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Zip | 85901-7328
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Country | US
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Telephone | 928-242-8870
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Fax | 928-532-1549
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR SIENA
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Credential | O.D.
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Telephone | 928-242-8870
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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 | 866
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License Number State | AZ
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