=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790972388
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | YUMA VISION CENTER, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2007
-----------------------------------------------------
Last Update Date | 07/26/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2750 S PACIFIC AVE STE D
-----------------------------------------------------
City | YUMA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85365-3547
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-782-7557
-----------------------------------------------------
Fax | 928-783-8445
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2750 S PACIFIC AVE STE D
-----------------------------------------------------
City | YUMA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85365-3547
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-782-7557
-----------------------------------------------------
Fax | 928-783-8445
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR OF OPTOMETRY
-----------------------------------------------------
Name | DR. THOMAS FRANCES DETERMAN
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 928-782-7557
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 663
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 786
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------