Provider Demographics
NPI:1154639664
Name:ORO VALLEY EYECARE, PLLC
Entity Type:Organization
Organization Name:ORO VALLEY EYECARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:520-229-2010
Mailing Address - Street 1:760 E PUSCH VIEW LN STE 100
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85737-9245
Mailing Address - Country:US
Mailing Address - Phone:520-229-2010
Mailing Address - Fax:520-229-2111
Practice Address - Street 1:760 E PUSCH VIEW LN STE 100
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85737-9245
Practice Address - Country:US
Practice Address - Phone:520-229-2010
Practice Address - Fax:520-229-2111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1535152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ154611Medicare PIN
AZZ154612Medicare UPIN