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General NPI Number Information
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NPI Number | 1437586005
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Entity Type | Organization
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Legal Business Name | EYEDEOLOGY VISION CENTER PLLC
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Dates
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Enumeration Date | 09/27/2013
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Last Update Date | 09/27/2013
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Provider Practice Location Address
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Address Line | 690 E WARNER RD STE 128
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City | GILBERT
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State | AZ
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Zip | 85296-3057
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Country | US
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Telephone | 480-248-6173
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Fax | 480-240-5972
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Provider Business Mailing Address
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Address Line | 690 E WARNER RD STE 128
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City | GILBERT
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State | AZ
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Zip | 85296-3057
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Country | US
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Telephone | 480-248-6173
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Fax | 480-240-5972
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | DR. KAREN STONEBRAKER SIMON
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Credential | OD
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Telephone | 480-248-6173
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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 | 998
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License Number State | AZ
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