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General NPI Number Information
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NPI Number | 1982102844
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Entity Type | Organization
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Legal Business Name | ELITE EYECARE CENTER PLLC
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Dates
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Enumeration Date | 01/25/2018
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 3383 W. MAIN ST.
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City | THATCHER
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State | AZ
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Zip | 85552
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Country | US
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Telephone | 928-792-4455
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Fax | 928-792-4463
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Provider Business Mailing Address
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Address Line | 3383 W. MAIN ST.
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City | THATCHER
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State | AZ
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Zip | 85552-5558
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Country | US
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Telephone | 928-792-4455
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Fax | 928-792-4463
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. ROBERT SCOTT SELLERS
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Credential | OD
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Telephone | 928-792-4455
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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 |
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License Number State |
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