Provider Demographics
NPI:1326587577
Name:NORTHERN ARIZONA OPTOMETRY, PLLC
Entity Type:Organization
Organization Name:NORTHERN ARIZONA OPTOMETRY, PLLC
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 1:420 N. HUMPHREYS ST.
Mailing Address - Street 2:
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 1:420 N. HUMPHREYS ST.
Practice Address - Street 2:
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:2017-02-21
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ1758152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ140639Medicare PIN