Provider Demographics
NPI:1407549660
Name:MOHL, PAIGE MCKENNA (OD)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:MCKENNA
Last Name:MOHL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23555 N DESERT PEAK PKWY APT 715
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-6314
Mailing Address - Country:US
Mailing Address - Phone:907-887-9414
Mailing Address - Fax:623-933-2962
Practice Address - Street 1:13340 N 94TH DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4236
Practice Address - Country:US
Practice Address - Phone:623-977-8341
Practice Address - Fax:623-933-2952
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOPT-002702152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist