Provider Demographics
NPI:1275755159
Name:MICHAEL J. DEPENBUSCH, M.D., PC
Entity Type:Organization
Organization Name:MICHAEL J. DEPENBUSCH, M.D., PC
Other - Org Name:ARIZONA EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEPENBUSCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-288-8447
Mailing Address - Street 1:604 W WARNER RD
Mailing Address - Street 2:SUITE B-6
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-2906
Mailing Address - Country:US
Mailing Address - Phone:480-963-3881
Mailing Address - Fax:480-899-8610
Practice Address - Street 1:604 W WARNER RD
Practice Address - Street 2:SUITE B-6
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-2906
Practice Address - Country:US
Practice Address - Phone:480-963-3881
Practice Address - Fax:480-899-8610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty