Provider Demographics
NPI:1477006724
Name:MOHAVE EYE CENTER, LTD
Entity Type:Organization
Organization Name:MOHAVE EYE CENTER, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHRINE
Authorized Official - Middle Name:
Authorized Official - Last Name:WINTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-753-2106
Mailing Address - Street 1:1925 FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-4617
Mailing Address - Country:US
Mailing Address - Phone:928-753-2106
Mailing Address - Fax:928-753-4283
Practice Address - Street 1:3003 HIGHWAY 95
Practice Address - Street 2:SUITE 11
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-7860
Practice Address - Country:US
Practice Address - Phone:928-763-1000
Practice Address - Fax:928-758-4983
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOHAVE EYE CENTER, LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1100290003OtherPTAN
AZZ20872OtherMEDICARE