MEDICARE: ARIZONA FOUNDATION FOR THE CHANGING EYE, INC.

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	207W00000X	Ophthalmology Physician

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	:	1639108335
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARIZONA FOUNDATION FOR THE CHANGING EYE, INC.

Provider Business Mailing Address
First Line	:	4020 N 20TH ST
Second Line	:	STE 215
City	:	PHOENIX
State	:	AZ
Zip	:	85016-6028
Country	:	US
Telephone Number	:	602-251-3400
Fax Number	:	602-466-1150

Provider Business Practice Location Address
First Line	:	4020 N 20TH ST
Second Line	:	STE 215
City	:	PHOENIX
State	:	AZ
Zip	:	85016-6028
Country	:	US
Telephone Number	:	602-251-3400
Fax Number	:	602-466-1150

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MS. ABAGAIL B GUIVER
Credential	:
Telephone Number	:	602-251-3400

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	10/31/2012

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