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General NPI Number Information
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NPI Number | 1750455234
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Entity Type | Organization
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Legal Business Name | SEVILLE EYE CENTER LLC
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 05/17/2010
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Provider Practice Location Address
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Address Line | 3336 E CHANDLER HEIGHTS RD BLDG A STE 104
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City | GILBERT
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State | AZ
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Zip | 85298-4259
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Country | US
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Telephone | 480-279-3937
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Fax | 480-889-2948
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Provider Business Mailing Address
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Address Line | 3336 E CHANDLER HEIGHTS RD BLDG A STE 104
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City | GILBERT
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State | AZ
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Zip | 85298-4259
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Country | US
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Telephone | 480-279-3937
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Fax | 480-889-2948
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | CHRISTOPHER C CARPENTER
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Credential | O.D.
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Telephone | 480-279-3937
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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 | AZ01104
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License Number State | AZ
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