Provider Demographics
NPI:1508533530
Name:IREFRACT PC
Entity Type:Organization
Organization Name:IREFRACT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:DREW
Authorized Official - Middle Name:
Authorized Official - Last Name:PROVOST
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:512-934-4444
Mailing Address - Street 1:8525 E PINNACLE PEAK RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-3581
Mailing Address - Country:US
Mailing Address - Phone:801-791-4100
Mailing Address - Fax:
Practice Address - Street 1:211 W BLACKSTOCK RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-1382
Practice Address - Country:US
Practice Address - Phone:864-256-3311
Practice Address - Fax:864-256-3322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty