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General NPI Number Information
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NPI Number | 1588948616
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Entity Type | Organization
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Legal Business Name | VISIONARY EYECARE PC
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Dates
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Enumeration Date | 10/07/2011
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Last Update Date | 09/11/2012
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Provider Practice Location Address
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Address Line | 2894 E WATERMAN CT
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City | GILBERT
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State | AZ
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Zip | 85297-7610
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Country | US
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Telephone | 480-532-2017
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Fax |
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Provider Business Mailing Address
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Address Line | 2894 E WATERMAN CT
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City | GILBERT
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State | AZ
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Zip | 85297-7610
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Country | US
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Telephone | 480-532-2017
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | JASON BAILEY
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Credential | OD
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Telephone | 480-532-2017
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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 | 1741
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License Number State | AZ
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