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General NPI Number Information
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NPI Number | 1982010773
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Entity Type | Organization
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Legal Business Name | PHOENIX EYE GROUP, LLC
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Dates
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Enumeration Date | 07/01/2014
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Last Update Date | 11/10/2014
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Provider Practice Location Address
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Address Line | 10250 N 92ND ST STE 105
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-4517
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Country | US
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Telephone | 480-237-3799
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Fax | 480-436-6760
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Provider Business Mailing Address
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Address Line | 21001 N TATUM BLVD STE 1630-609
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City | PHOENIX
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State | AZ
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Zip | 85050-4242
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Country | US
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Telephone | 480-237-3799
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Fax | 480-436-6760
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Authorized Official
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Title or Position | OWNER
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Name | EVA-MARIE CHONG
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Credential | MD
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Telephone | 480-237-3799
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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 | 35603
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License Number State | AZ
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