Provider Demographics
NPI:1568742385
Name:BUENA VISTA EYECARE P. C.
Entity Type:Organization
Organization Name:BUENA VISTA EYECARE P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNIE
Authorized Official - Middle Name:RAUL
Authorized Official - Last Name:TREJO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:520-889-7766
Mailing Address - Street 1:2680 E VALENCIA RD STE 188
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85706-5962
Mailing Address - Country:US
Mailing Address - Phone:520-889-7766
Mailing Address - Fax:520-889-2306
Practice Address - Street 1:2680 E VALENCIA RD STE 188
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85706-5962
Practice Address - Country:US
Practice Address - Phone:520-889-7766
Practice Address - Fax:520-889-2306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ664152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZT42220Medicare UPIN