Provider Demographics
NPI:1487845764
Name:ARIZONA INSTITUTE OF EYE SURGERY LLC
Entity Type:Organization
Organization Name:ARIZONA INSTITUTE OF EYE SURGERY LLC
Other - Org Name:PRESCOTT VISION & EYE SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:D
Authorized Official - Last Name:BROOKFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-598-7488
Mailing Address - Street 1:63 S ROCKFORD DR STE 220
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85288-6226
Mailing Address - Country:US
Mailing Address - Phone:602-598-7488
Mailing Address - Fax:602-231-6215
Practice Address - Street 1:3192 WILLOW CREEK RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-6610
Practice Address - Country:US
Practice Address - Phone:928-778-3950
Practice Address - Fax:928-778-3999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ207W00000X
AZOSC4258261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ4498OtherPHYSICIAN MEDICAL LICENSE
AZ190721Medicaid
572818OtherRAN & AMN
AZ03-C0001215OtherMEDICARE CCN
3421045OtherCIGNA
7442967OtherAETNA
AZ280244Medicaid
DM2NNPOtherARIZONA FOUNDATION
033176-001OtherMERCYCARE
2Z6546OtherHEALTHNET
866291-9714OtherHUMANA