Provider Demographics
NPI:1235315482
Name:CENTRAL ARIZONA EYE CLINIC P.C.
Entity Type:Organization
Organization Name:CENTRAL ARIZONA EYE CLINIC P.C.
Other - Org Name:RUMMEL OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:RUMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-772-6246
Mailing Address - Street 1:2517 N GREAT WESTERN DR
Mailing Address - Street 2:SUITE I
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-2597
Mailing Address - Country:US
Mailing Address - Phone:928-772-6246
Mailing Address - Fax:928-772-9329
Practice Address - Street 1:2517 N GREAT WESTERN DR
Practice Address - Street 2:SUITE I
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-2597
Practice Address - Country:US
Practice Address - Phone:928-772-6246
Practice Address - Fax:928-772-9329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ193588332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ305583Medicaid
AZ0381170002Medicare NSC