Provider Demographics
NPI:1417613043
Name:PERSONAL EYES LLC
Entity Type:Organization
Organization Name:PERSONAL EYES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RIC
Authorized Official - Middle Name:R
Authorized Official - Last Name:RIOS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:602-373-2996
Mailing Address - Street 1:1107 E SHANGRI LA RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-5842
Mailing Address - Country:US
Mailing Address - Phone:602-661-7006
Mailing Address - Fax:
Practice Address - Street 1:15600 N BLACK CANYON HWY STE C102
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-4055
Practice Address - Country:US
Practice Address - Phone:602-661-7006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty