Provider Demographics
NPI:1043246416
Name:CENTRAL PHOENIX EYE CARE, PLLC
Entity Type:Organization
Organization Name:CENTRAL PHOENIX EYE CARE, PLLC
Other - Org Name:CENTRAL PHOENIX EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:HARRY
Authorized Official - Last Name:KANTOR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:602-265-8597
Mailing Address - Street 1:5727 N 7TH ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-5809
Mailing Address - Country:US
Mailing Address - Phone:602-265-8597
Mailing Address - Fax:602-265-6811
Practice Address - Street 1:5727 N 7TH ST
Practice Address - Street 2:SUITE 105
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-5809
Practice Address - Country:US
Practice Address - Phone:602-265-8597
Practice Address - Fax:602-265-6811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ350152W00000X
AZ588152W00000X
AZ1326152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ75997Medicare PIN
AZ5003290001Medicare NSC