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General NPI Number Information
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NPI Number | 1750685657
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Entity Type | Organization
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Legal Business Name | HEALTHY EYES PLLC
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Dates
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Enumeration Date | 01/06/2011
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Last Update Date | 01/06/2011
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Provider Practice Location Address
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Address Line | 4568 E CACTUS RD
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City | PHOENIX
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State | AZ
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Zip | 85032-7702
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Country | US
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Telephone | 623-224-7001
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Fax |
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Provider Business Mailing Address
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Address Line | 16110 W HUALAPAI ST
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City | GOODYEAR
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State | AZ
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Zip | 85338-7941
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Country | US
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Telephone |
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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. DURGA YERRAMILLI
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Credential | OD
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Telephone | 623-224-7001
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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 | 1618
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License Number State | AZ
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