MEDICARE: ENVISION EYECARE CENTER PC

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	AZ-013	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
2	5801810001	OTHER	AZ	DMEPOS-SUPPLIER NO.

General Provider Information

NPI Number	:	1154461747
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENVISION EYECARE CENTER PC

Provider Business Mailing Address
First Line	:	525 W WETMORE RD STE 101
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85705-5094
Country	:	US
Telephone Number	:	520-293-2363
Fax Number	:	520-293-0475

Provider Business Practice Location Address
First Line	:	525 W WETMORE RD STE 101
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85705-5094
Country	:	US
Telephone Number	:	520-293-2363
Fax Number	:	520-293-0475

Authorized Official
Title or Position	:	OWNER, CEO
Name	:	DR. PATRICK J BARRY
Credential	:	O.D.
Telephone Number	:	520-293-2363

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	12/13/2007

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Directions to “ENVISION EYECARE CENTER PC ” Practice Location

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