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General NPI Number Information
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NPI Number | 1750887006
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Entity Type | Organization
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Legal Business Name | FAMILY TREE EYE CARE LLC
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Dates
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Enumeration Date | 04/04/2018
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Last Update Date | 04/04/2018
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Provider Practice Location Address
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Address Line | 67 S HIGLEY RD STE 104
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City | GILBERT
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State | AZ
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Zip | 85296-1167
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Country | US
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Telephone | 480-382-5008
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Fax |
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Provider Business Mailing Address
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Address Line | 2625 E VALENCIA ST
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City | GILBERT
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State | AZ
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Zip | 85296-8671
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Country | US
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Telephone | 480-603-5161
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Fax |
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Authorized Official
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Title or Position | OWNER OPTOMETRIST
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Name | DR. ALMA DAVID YAMAMOTO
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Credential | OD
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Telephone | 480-603-5161
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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 | 1759
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License Number State | AZ
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