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General NPI Number Information
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NPI Number | 1912149998
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Entity Type | Organization
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Legal Business Name | CL EYE CARE, PLLC
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Dates
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Enumeration Date | 04/06/2009
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Last Update Date | 04/06/2009
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Provider Practice Location Address
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Address Line | 10615 W THUNDERBIRD BLVD SUITE D-500
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City | SUN CITY
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State | AZ
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Zip | 85351-3033
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Country | US
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Telephone | 602-910-0069
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Fax |
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Provider Business Mailing Address
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Address Line | 1104 W LYDIA LN
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City | PHOENIX
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State | AZ
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Zip | 85041-5924
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Country | US
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Telephone | 602-910-0069
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Fax |
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Authorized Official
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Title or Position | C.E.O.
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Name | DR. CHRISTOPHER P. MARMO
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Credential | O.D.
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Telephone | 602-910-0069
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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 | 1437
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License Number State | AZ
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