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General NPI Number Information
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NPI Number | 1861676934
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Entity Type | Organization
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Legal Business Name | SOUTHWESTERN GLAUCOMA CONSULTANTS
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Dates
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Enumeration Date | 12/24/2007
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Last Update Date | 12/24/2007
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Provider Practice Location Address
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Address Line | 10615 W THUNDERBIRD BLVD B300
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City | SUN CITY
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State | AZ
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Zip | 85351
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Country | US
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Telephone | 623-933-0176
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Fax | 623-933-2808
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Provider Business Mailing Address
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Address Line | 10615 W THUNDERBIRD BLVD B300 SOUTHWESTERN GLAUCOMA CONSULTANTS LTD
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City | SUN CITY
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State | AZ
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Zip | 85351
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Country | US
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Telephone | 623-933-0176
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Fax | 623-933-2808
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. KENNETH A BATKO
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Credential | MD
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Telephone | 623-933-0176
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 11931
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License Number State | AZ
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