Provider Demographics
NPI:1164853297
Name:ADVANCED RETINA AND EYE CANCER CENTER, LLC
Entity Type:Organization
Organization Name:ADVANCED RETINA AND EYE CANCER CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MADHAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:KURLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-397-9560
Mailing Address - Street 1:8776 E SHEA BLVD
Mailing Address - Street 2:SUITE 106-330
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6629
Mailing Address - Country:US
Mailing Address - Phone:480-397-9560
Mailing Address - Fax:480-397-9561
Practice Address - Street 1:19820 N 7TH ST
Practice Address - Street 2:SUITE 120
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85024-1689
Practice Address - Country:US
Practice Address - Phone:480-397-9560
Practice Address - Fax:480-397-9561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-27
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ44792207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty