MEDICARE: SAGUARO OPHTHALMOLOGY, LLC

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	207WX0009X	Glaucoma Specialist (Ophthalmology) Physician

General Provider Information

NPI Number	:	1588249809
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAGUARO OPHTHALMOLOGY, LLC

Provider Business Mailing Address
First Line	:	1760 E PECOS RD STE 201
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85295-3202
Country	:	US
Telephone Number	:	480-590-2039
Fax Number	:

Provider Business Practice Location Address
First Line	:	1760 E PECOS RD STE 201
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85295-3202
Country	:	US
Telephone Number	:	480-590-2039
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. TRENTON JAMES BOWEN
Credential	:	MD
Telephone Number	:	480-590-2039

Provider Enumeration Date	:	03/17/2021
Last Update Date	:	07/12/2021

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