Provider Demographics
NPI:1144567173
Name:CLASIK VISION CARE PLLC
Entity Type:Organization
Organization Name:CLASIK VISION CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROTHLISBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:480-861-0590
Mailing Address - Street 1:3125 W HUNT HWY # B-102
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-9315
Mailing Address - Country:US
Mailing Address - Phone:480-525-2025
Mailing Address - Fax:480-422-8749
Practice Address - Street 1:3125 W HUNT HWY # B-102
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85142-9315
Practice Address - Country:US
Practice Address - Phone:480-525-2025
Practice Address - Fax:480-422-8749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-10
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ791152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty