MEDICARE: ARIZONA GLAUCOMA SPECIALISTS - MESA PLLC

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	:	1912512633
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARIZONA GLAUCOMA SPECIALISTS - MESA PLLC

Provider Business Mailing Address
First Line	:	6599 N ORACLE RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-5614
Country	:	US
Telephone Number	:	520-544-4393
Fax Number	:	520-544-0098

Provider Business Practice Location Address
First Line	:	6402 E SUPERSTITION SPRINGS BLVD STE 104
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-4391
Country	:	US
Telephone Number	:	480-396-9339
Fax Number	:	480-699-9906

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JEFFREY STUART KAY
Credential	:	MD
Telephone Number	:	520-904-0714

Provider Enumeration Date	:	09/10/2020
Last Update Date	:	09/10/2020

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