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General NPI Number Information
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NPI Number | 1588146146
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Entity Type | Organization
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Legal Business Name | EYES ON MESA, PLLC
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Dates
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Enumeration Date | 08/30/2018
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Last Update Date | 08/30/2018
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Provider Practice Location Address
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Address Line | 2048 E BASELINE RD
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City | MESA
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State | AZ
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Zip | 85204-6969
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Country | US
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Telephone | 480-632-5075
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Fax |
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Provider Business Mailing Address
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Address Line | 3971 E HEATHER CT
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City | GILBERT
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State | AZ
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Zip | 85234-3210
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Country | US
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Telephone | 440-554-4915
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. HERLYNNE MARTIN
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Credential | OD
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Telephone | 440-554-4915
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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 | 1973
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License Number State | AZ
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