Provider Demographics
NPI:1154452274
Name:EYE INSTITUTE OF SOUTHERN ARIZONA
Entity Type:Organization
Organization Name:EYE INSTITUTE OF SOUTHERN ARIZONA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:KUSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-790-8888
Mailing Address - Street 1:5632 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-2444
Mailing Address - Country:US
Mailing Address - Phone:520-790-8888
Mailing Address - Fax:520-790-1427
Practice Address - Street 1:5632 E 5TH ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-2444
Practice Address - Country:US
Practice Address - Phone:520-790-8888
Practice Address - Fax:520-790-1427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2009-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ70468Medicare ID - Type Unspecified