Provider Demographics
NPI:1336107036
Name:RUMMEL EYE CARE, P.C.
Entity Type:Organization
Organization Name:RUMMEL EYE CARE, P.C.
Other - Org Name:RUMMEL EYE CARE/EYE SURGERY SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-445-1341
Mailing Address - Street 1:1022 WILLOW CREEK RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-1607
Mailing Address - Country:US
Mailing Address - Phone:928-445-1341
Mailing Address - Fax:
Practice Address - Street 1:1022 WILLOW CREEK RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1607
Practice Address - Country:US
Practice Address - Phone:928-445-1341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOSC0079261QA1903X, 261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ310285Medicaid
AZ310285Medicaid