MEDICARE: OPHTHALMIC NURSING CARE OF ARIZONA 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	163WH0200X	Home Health Registered Nurse	RN028029	AZ
2	163WX1100X	Ophthalmic Registered Nurse	RN028029	AZ

General Provider Information

NPI Number	:	1649506049
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPHTHALMIC NURSING CARE OF ARIZONA INC.

Provider Business Mailing Address
First Line	:	2202 E BELMONT AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020-4721
Country	:	US
Telephone Number	:	602-279-9657
Fax Number	:	602-285-1518

Provider Business Practice Location Address
First Line	:	2202 E BELMONT AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020-4721
Country	:	US
Telephone Number	:	602-279-9657
Fax Number	:	602-285-1518

Authorized Official
Title or Position	:	VICE PRESIDENT, TREASURER
Name	:	MR. DAVID M LAMB
Credential	:
Telephone Number	:	602-228-8921

Provider Enumeration Date	:	10/20/2009
Last Update Date	:	10/20/2009

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