Provider Demographics
NPI:1275001927
Name:ARIZONA VISION OF MESA PLC
Entity Type:Organization
Organization Name:ARIZONA VISION OF MESA PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:GILBUENA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:480-615-9010
Mailing Address - Street 1:45680 W BARBARA LN
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85139-7230
Mailing Address - Country:US
Mailing Address - Phone:503-412-8627
Mailing Address - Fax:
Practice Address - Street 1:1425 S ALMA SCHOOL RD STE 103
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-2000
Practice Address - Country:US
Practice Address - Phone:480-615-9010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-09
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty