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General NPI Number Information
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NPI Number | 1851076384
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Entity Type | Individual
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Provider Name | WHITNEY BALLASH OD
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Gender | Female
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Dates
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Enumeration Date | 06/21/2023
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Last Update Date | 07/28/2023
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Provider Practice Location Address
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Address Line | 2330 N 75TH AVE STE 101
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City | PHOENIX
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State | AZ
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Zip | 85035-1200
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Country | US
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Telephone | 623-849-8726
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Fax | 623-849-8871
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Provider Business Mailing Address
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Address Line | 12605 N TATUM BLVD # A111
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City | PHOENIX
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State | AZ
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Zip | 85032-7710
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Country | US
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Telephone | 602-494-7336
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | OPT-002713
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License Number State | AZ
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