Provider Demographics
NPI:1265486872
Name:LUNA EYE CENTERS OF PHOENIX AZ PC
Entity Type:Organization
Organization Name:LUNA EYE CENTERS OF PHOENIX AZ PC
Other - Org Name:LUNA HEALTHCARE MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMERON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-553-9800
Mailing Address - Street 1:2501 N 32ND ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-2104
Mailing Address - Country:US
Mailing Address - Phone:602-957-6799
Mailing Address - Fax:602-957-0172
Practice Address - Street 1:2501 N 32ND ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-2104
Practice Address - Country:US
Practice Address - Phone:602-957-6799
Practice Address - Fax:602-957-0172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ152W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty