MEDICARE: ARIEL ESQUIBEL OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OPT34381-TLG	CA
2	152W00000X	Optometrist	OPT-002324	AZ

General Provider Information

NPI Number	:	1023503810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARIEL ESQUIBEL OD

Provider Business Mailing Address
First Line	:	920 HARROD WAY
Second Line	:
City	:	KINGMAN
State	:	AZ
Zip	:	86401-5339
Country	:	US
Telephone Number	:	928-727-3220
Fax Number	:

Provider Business Practice Location Address
First Line	:	383 LAKE HAVASU AVE S
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-9368
Country	:	US
Telephone Number	:	928-680-1144
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2018
Last Update Date	:	09/27/2022

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