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General NPI Number Information
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NPI Number | 1962938225
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Entity Type | Organization
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Legal Business Name | EVOLUTION VISION CARE, PLLC
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Dates
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Enumeration Date | 05/05/2017
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Last Update Date | 02/09/2022
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Provider Practice Location Address
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Address Line | 1955 S STAPLEY DR
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City | MESA
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State | AZ
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Zip | 85204-6615
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Country | US
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Telephone | 321-514-5833
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Fax |
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Provider Business Mailing Address
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Address Line | 4096 E ALAMOSA PL
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City | CHANDLER
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State | AZ
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Zip | 85249-9733
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | DR. SONAL DESAI
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Credential | O.D.
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Telephone | 321-514-5833
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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 | 2092
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License Number State | AZ
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