Provider Demographics
NPI:1538496294
Name:BRICELAND ENTERPRISES PLC
Entity Type:Organization
Organization Name:BRICELAND ENTERPRISES PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRICELAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-546-2020
Mailing Address - Street 1:13624 W CAMINO DEL SOL STE 200
Mailing Address - Street 2:
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-3401
Mailing Address - Country:US
Mailing Address - Phone:623-546-2020
Mailing Address - Fax:623-546-2399
Practice Address - Street 1:13624 W CAMINO DEL SOL STE 200
Practice Address - Street 2:
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-3401
Practice Address - Country:US
Practice Address - Phone:623-546-2020
Practice Address - Fax:623-546-2399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ18851156FX1100X
AZ19009174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmicGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZMD18851AMedicare UPIN