Provider Demographics
NPI:1356488175
Name:NORTHWEST EYE SPECIALISTS, LLC
Entity Type:Organization
Organization Name:NORTHWEST EYE SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LANSBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:520-293-6740
Mailing Address - Street 1:5599 N ORACLE RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-3821
Mailing Address - Country:US
Mailing Address - Phone:520-293-6740
Mailing Address - Fax:520-293-6771
Practice Address - Street 1:5599 N ORACLE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-3821
Practice Address - Country:US
Practice Address - Phone:520-293-6740
Practice Address - Fax:520-293-6771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0771570001Medicare NSC