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General NPI Number Information
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NPI Number | 1780855668
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Entity Type | Organization
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Legal Business Name | NORTHLAND EYE CARE PC
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Dates
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Enumeration Date | 03/18/2008
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Last Update Date | 01/25/2022
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Provider Practice Location Address
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Address Line | 2050 S WOODLANDS VILLAGE BLVD STE 3
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-2972
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Country | US
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Telephone | 928-226-9300
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Fax | 928-226-8651
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Provider Business Mailing Address
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Address Line | 2050 S WOODLANDS VILLAGE BLVD STE 3
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-2972
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Country | US
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Telephone | 928-226-9300
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Fax | 928-226-8651
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | HEIDI M HIPSHER
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Credential | LDO
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Telephone | 928-226-9300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | AZ1203
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License Number State | AZ
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