Provider Demographics
NPI:1134639537
Name:SONORAN DESERT OPTOMETRIC MANAGEMENT PC
Entity Type:Organization
Organization Name:SONORAN DESERT OPTOMETRIC MANAGEMENT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OD
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:A
Authorized Official - Last Name:PRESCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER/OD
Authorized Official - Phone:520-293-2363
Mailing Address - Street 1:525 W WETMORE RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-5093
Mailing Address - Country:US
Mailing Address - Phone:520-293-2363
Mailing Address - Fax:520-293-0475
Practice Address - Street 1:525 W WETMORE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-5093
Practice Address - Country:US
Practice Address - Phone:520-293-2363
Practice Address - Fax:520-293-0475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-11
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty