Provider Demographics
NPI:1003249798
Name:GOODYEAR EYE SPECIALISTS LLC
Entity Type:Organization
Organization Name:GOODYEAR EYE SPECIALISTS LLC
Other - Org Name:GOODYEAR EYE SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-363-1421
Mailing Address - Street 1:13657 W MCDOWELL RD STE 209
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-2603
Mailing Address - Country:US
Mailing Address - Phone:623-363-1421
Mailing Address - Fax:
Practice Address - Street 1:13657 W MCDOWELL RD STE 209
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2603
Practice Address - Country:US
Practice Address - Phone:623-363-1421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-16
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35744207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty