Provider Demographics
NPI:1346423266
Name:OPTICS OF SCOTTSDALE LLC
Entity Type:Organization
Organization Name:OPTICS OF SCOTTSDALE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:INGRAM
Authorized Official - Last Name:RAGO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:480-563-0908
Mailing Address - Street 1:20301 N HAYDEN RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-3881
Mailing Address - Country:US
Mailing Address - Phone:480-991-0509
Mailing Address - Fax:
Practice Address - Street 1:20301 N HAYDEN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-3881
Practice Address - Country:US
Practice Address - Phone:480-991-0509
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ973152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty