Provider Demographics
NPI:1164464343
Name:SCOTTSDALE EYE INSTITUTE, PLC
Entity Type:Organization
Organization Name:SCOTTSDALE EYE INSTITUTE, PLC
Other - Org Name:SCOTTSDALE EYE INSTITUTE, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TARIQ
Authorized Official - Middle Name:U
Authorized Official - Last Name:QAMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-661-1600
Mailing Address - Street 1:9201 E. MOUNTAIN VIEW ROAD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258
Mailing Address - Country:US
Mailing Address - Phone:480-661-1600
Mailing Address - Fax:480-661-1809
Practice Address - Street 1:9201 E. MOUNTAIN VIEW ROAD
Practice Address - Street 2:SUITE 125
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258
Practice Address - Country:US
Practice Address - Phone:480-661-1600
Practice Address - Fax:480-661-1809
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SCOTTSDALE EYE INSTITUTE, PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-12
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X
AZ261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ75690Medicare PIN
AZ75690Medicare ID - Type Unspecified