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NPI 1407083983

NPI 1407083983 : ARIZONA LASIK INSTITUTE : PHOENIX, AZ

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General NPI Number Information
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    NPI Number           |    1407083983
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    Entity Type          |    Organization 
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    Legal Business Name  |    ARIZONA LASIK INSTITUTE 
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Dates
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    Enumeration Date     |    06/11/2009
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    Last Update Date     |    06/11/2009
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Provider Practice Location Address
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    Address Line         |    300 E. OSBORN ROAD SUITE 202
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    City                 |    PHOENIX
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    State                |    AZ
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    Zip                  |    85012-2347
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    Country              |    US
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    Telephone            |    602-277-1559
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    Fax                  |    602-274-7226
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Provider Business Mailing Address
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    Address Line         |    300 E. OSBORN ROAD SUITE 202
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    City                 |    PHOENIX
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    State                |    AZ
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    Zip                  |    85012-2347
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    Country              |    US
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    Telephone            |    602-277-1559
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    Fax                  |    602-274-7226
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Authorized Official
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    Title or Position    |    OFFICE MANAGER
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    Name                 |    MRS. ROSEMARY  ROSS-GRINNELL 
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    Credential           |    
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    Telephone            |    602-277-1559
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    261QA1903X
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    Taxonomy Name        |    Ambulatory Surgical Clinic/Center
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    License Number       |    
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    License Number State |    
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