Provider Demographics
NPI:1043567936
Name:VISION EDGE EYE CENTER PLC
Entity Type:Organization
Organization Name:VISION EDGE EYE CENTER PLC
Other - Org Name:VISION EDGE EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:STAMPER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:480-961-8999
Mailing Address - Street 1:7130 W CHANDLER BLVD STE 19
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-3241
Mailing Address - Country:US
Mailing Address - Phone:480-961-8999
Mailing Address - Fax:480-961-5009
Practice Address - Street 1:7130 W CHANDLER BLVD STE 19
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-3241
Practice Address - Country:US
Practice Address - Phone:480-961-8999
Practice Address - Fax:480-961-5009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-09
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1359152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ92893OtherPTAN
AZZ92893OtherPTAN