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NPI Code Detail

MEDICARE: EYE CARE FOR KIDS ARIZONA CHAPTER INC

MEDICARE: EYE CARE FOR KIDS ARIZONA CHAPTER 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
1156FC0800XContact Lens Technician/Technologist
2156FC0801XContact Lens Fitter
3332H00000XEyewear Supplier
4152W00000XOptometrist

General Provider Information

NPI Number : 1639723471
Entity Type Code : Organization
Provider Name (Legal Business Name) : EYE CARE FOR KIDS ARIZONA CHAPTER INC
Provider Business Mailing Address
First Line : 6911 S STATE ST
Second Line :
City : MIDVALE
State : UT
Zip : 84047-1239
Country : US
Telephone Number : 801-285-5443
Fax Number : 801-255-8526
Provider Business Practice Location Address
First Line : 6615 N 39TH AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85019-1334
Country : US
Telephone Number : 801-285-5443
Fax Number :
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MR. JOSEPH G CARBONE
Credential : ABOC, NCLC
Telephone Number : 801-285-5443
Provider Enumeration Date : 07/30/2019
Last Update Date : 07/30/2019

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Directions to “EYE CARE FOR KIDS ARIZONA CHAPTER INC ” Practice Location

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