Provider Demographics
NPI:1285200022
Name:OPTOMETRIC CONSULTING SERVICES, INC
Entity Type:Organization
Organization Name:OPTOMETRIC CONSULTING SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:DETERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:928-580-6356
Mailing Address - Street 1:2750 S PACIFIC AVE STE D
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-3547
Mailing Address - Country:US
Mailing Address - Phone:928-580-6356
Mailing Address - Fax:928-783-8445
Practice Address - Street 1:2750 S PACIFIC AVE STE D
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365-3547
Practice Address - Country:US
Practice Address - Phone:928-580-6356
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty