Provider Demographics
NPI:1154461747
Name:ENVISION EYECARE CENTER PC
Entity Type:Organization
Organization Name:ENVISION EYECARE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:BARRY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:520-293-2363
Mailing Address - Street 1:525 W WETMORE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-5094
Mailing Address - Country:US
Mailing Address - Phone:520-293-2363
Mailing Address - Fax:520-293-0475
Practice Address - Street 1:525 W WETMORE RD STE 101
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-5094
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:2007-02-06
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ-013152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ867480Medicaid
AZ5801810001OtherDMEPOS-SUPPLIER NO.
AZ5801810001OtherDMEPOS-SUPPLIER NO.
Z78758Medicare PIN