MEDICARE: DR. BRIAN A MACH 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	0551	AZ

Other Identifiers

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

General Provider Information

NPI Number	:	1093711939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN A MACH OD

Provider Business Mailing Address
First Line	:	PO BOX 16996
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85011-6996
Country	:	US
Telephone Number	:	602-424-0866
Fax Number	:	602-424-0865

Provider Business Practice Location Address
First Line	:	5620 W THUNDERBIRD RD
Second Line	:	#H-3
City	:	GLENDALE
State	:	AZ
Zip	:	85306-4636
Country	:	US
Telephone Number	:	602-424-0866
Fax Number	:	602-424-0865

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

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	05/09/2011

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