Provider Demographics
NPI:1467741827
Name:LAVEEN TOTAL EYECARE
Entity Type:Organization
Organization Name:LAVEEN TOTAL EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TORRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:480-414-5022
Mailing Address - Street 1:5030 W BASELINE RD STE 135
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-7331
Mailing Address - Country:US
Mailing Address - Phone:602-237-4777
Mailing Address - Fax:602-237-1205
Practice Address - Street 1:5030 W BASELINE RD STE 135
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-7331
Practice Address - Country:US
Practice Address - Phone:602-237-4777
Practice Address - Fax:602-237-1205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-06
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1205152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty