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General NPI Number Information
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NPI Number | 1902133739
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Entity Type | Organization
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Legal Business Name | I DRS, INC.
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Dates
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Enumeration Date | 11/16/2009
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Last Update Date | 11/16/2009
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Provider Practice Location Address
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Address Line | 42201 N 41ST DR SUITE 144
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City | ANTHEM
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State | AZ
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Zip | 85086-3800
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Country | US
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Telephone | 623-551-9122
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Fax | 623-551-9120
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Provider Business Mailing Address
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Address Line | 42201 N 41ST DR SUITE 144
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City | ANTHEM
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State | AZ
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Zip | 85086-3800
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Country | US
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Telephone | 623-551-9122
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Fax | 623-551-9120
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID PAUL SHIBATA
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Credential | O.D.
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Telephone | 623-551-9122
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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 | 1174
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License Number State | AZ
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