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General NPI Number Information
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NPI Number | 1407190598
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Entity Type | Organization
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Legal Business Name | CAPELLA EYECARE
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Dates
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Enumeration Date | 11/15/2012
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Last Update Date | 03/26/2014
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Provider Practice Location Address
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Address Line | 12625 N SAGUARO BLVD SUITE 106
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City | FOUNTAIN HILLS
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State | AZ
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Zip | 85268-4183
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Country | US
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Telephone | 480-656-2111
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Fax | 480-621-8879
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Provider Business Mailing Address
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Address Line | 12625 N SAGUARO BLVD SUITE 106
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City | FOUNTAIN HILLS
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State | AZ
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Zip | 85268-4183
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Country | US
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Telephone | 480-656-2111
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Fax | 480-621-8879
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Authorized Official
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Title or Position | DOCTOR
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Name | HA ANH PHAM-JIBBEN
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Credential | OD
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Telephone | 480-656-2111
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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 | 1466
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License Number State | AZ
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