Provider Demographics
NPI:1376871079
Name:ARIZONA CONTACT LENS CONSULTANTS PLLC
Entity Type:Organization
Organization Name:ARIZONA CONTACT LENS CONSULTANTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DR
Authorized Official - Middle Name:
Authorized Official - Last Name:SIENA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:928-242-8870
Mailing Address - Street 1:1071 E PINE OAKS DR
Mailing Address - Street 2:
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-7328
Mailing Address - Country:US
Mailing Address - Phone:928-242-8870
Mailing Address - Fax:928-532-1549
Practice Address - Street 1:5401 S WHITE MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-7849
Practice Address - Country:US
Practice Address - Phone:928-532-1547
Practice Address - Fax:928-532-1549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-18
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ866152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU46176Medicare UPIN