=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578714622
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARIZONA OCULOPLASTIC SPECIALISTS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2008
-----------------------------------------------------
Last Update Date | 04/23/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9431 E IRONWOOD SQUARE DRIVE
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85258-3696
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-905-1010
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9431 E IRONWOOD SQUARE DRIVE
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85258-4572
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-905-1010
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ALI GHAFOURI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 480-650-1386
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | 27072
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------