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General NPI Number Information
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NPI Number | 1609040187
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Entity Type | Organization
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Legal Business Name | JAMES L. ABBOTT, OD, PC
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Dates
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Enumeration Date | 04/16/2008
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Last Update Date | 04/16/2008
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Provider Practice Location Address
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Address Line | 1919 E MCKELLIPS RD SUTIE 103
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City | MESA
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State | AZ
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Zip | 85203-2844
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Country | US
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Telephone | 480-844-2286
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Fax | 480-610-6641
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Provider Business Mailing Address
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Address Line | 1919 E MCKELLIPS RD SUTIE 103
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City | MESA
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State | AZ
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Zip | 85203-2844
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Country | US
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Telephone | 480-844-2286
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Fax | 480-610-6641
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Authorized Official
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Title or Position | OWNER
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Name | JAMES L. ABBOTT II
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Credential | OD
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Telephone | 480-844-2286
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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 | 338
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License Number State | AZ
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