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NPI Code Detail

MEDICARE: UNIVERSITY OPTOMETRY, PLLC

MEDICARE: UNIVERSITY OPTOMETRY, PLLC
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
1152W00000XOptometrist1643AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1083125850
Entity Type Code : Organization
Provider Name (Legal Business Name) : UNIVERSITY OPTOMETRY, PLLC
Provider Business Mailing Address
First Line : 1700 E FORT LOWELL RD STE 103
Second Line :
City : TUCSON
State : AZ
Zip : 85719-2395
Country : US
Telephone Number : 520-325-8700
Fax Number : 520-462-8730
Provider Business Practice Location Address
First Line : 1700 E FORT LOWELL RD STE 103
Second Line :
City : TUCSON
State : AZ
Zip : 85719-2395
Country : US
Telephone Number : 520-325-8700
Fax Number : 520-462-8730
Authorized Official
Title or Position : OWNER
Name : DR. JACOB W HISCOX
Credential : OD
Telephone Number : 520-325-8700
Provider Enumeration Date : 10/19/2017
Last Update Date : 03/11/2022

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Directions to “UNIVERSITY OPTOMETRY, PLLC ” Practice Location

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