Provider Demographics
NPI:1568502813
Name:FLORES, JAMES E (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:E
Last Name:FLORES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 N 22ND ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4701
Mailing Address - Country:US
Mailing Address - Phone:602-598-7495
Mailing Address - Fax:480-892-1889
Practice Address - Street 1:1815 N MASTICK WAY
Practice Address - Street 2:
Practice Address - City:NOGALES
Practice Address - State:AZ
Practice Address - Zip Code:85621-1046
Practice Address - Country:US
Practice Address - Phone:520-761-3533
Practice Address - Fax:520-281-1950
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ517152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ034827Medicaid