Provider Demographics
NPI:1013016682
Name:SUN CITY WEST EYE CARE PLLC
Entity Type:Organization
Organization Name:SUN CITY WEST EYE CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:SIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-544-3877
Mailing Address - Street 1:13540 W.CAMINO DEL SOL
Mailing Address - Street 2:SUITE 17
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-4472
Mailing Address - Country:US
Mailing Address - Phone:623-544-3877
Mailing Address - Fax:623-544-3834
Practice Address - Street 1:13540 W CAMINO DEL SOL
Practice Address - Street 2:SUITE 17
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-4434
Practice Address - Country:US
Practice Address - Phone:623-544-3877
Practice Address - Fax:623-544-3834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1189152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ117495Medicare PIN