Provider Demographics
NPI:1285819136
Name:NORTHERN ARIZONA OPTOMETRY
Entity Type:Organization
Organization Name:NORTHERN ARIZONA OPTOMETRY
Other - Org Name:EYE CARE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MCQUIVEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:928-774-7949
Mailing Address - Street 1:940 N SWITZER CANYON DR.
Mailing Address - Street 2:STE 101
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001
Mailing Address - Country:US
Mailing Address - Phone:928-774-7949
Mailing Address - Fax:928-774-7207
Practice Address - Street 1:940 N SWITZER CANYON DR.
Practice Address - Street 2:STE 101
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001
Practice Address - Country:US
Practice Address - Phone:928-774-7949
Practice Address - Fax:928-774-7207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ00800152W00000X
152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP00767447Medicare PIN
AZZ79176Medicare PIN
AZZ140639Medicare UPIN