Provider Demographics
NPI:1518208453
Name:STUART EYE CENTRE
Entity Type:Organization
Organization Name:STUART EYE CENTRE
Other - Org Name:STUART EYE CENTRE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VIRGIL
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:STUART
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:928-524-6171
Mailing Address - Street 1:421 E IOWA ST
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:AZ
Mailing Address - Zip Code:86025-2770
Mailing Address - Country:US
Mailing Address - Phone:928-524-6171
Mailing Address - Fax:928-524-3963
Practice Address - Street 1:421 E IOWA ST
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:AZ
Practice Address - Zip Code:86025-2770
Practice Address - Country:US
Practice Address - Phone:928-524-6171
Practice Address - Fax:928-524-3963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ229152W00000X
AZ1414152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ52668398Medicare UPIN