Provider Demographics
NPI:1104039569
Name:WESTERN MEDICAL EYE CENTER
Entity Type:Organization
Organization Name:WESTERN MEDICAL EYE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:STANFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-763-8443
Mailing Address - Street 1:1800 HIGHWAY 95
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-6803
Mailing Address - Country:US
Mailing Address - Phone:928-763-8443
Mailing Address - Fax:
Practice Address - Street 1:1800 HIGHWAY 95
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-6803
Practice Address - Country:US
Practice Address - Phone:928-763-8443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0271230001Medicare NSC
AZZWMBNSMedicare ID - Type Unspecified