Provider Demographics
NPI:1578139424
Name:TRAVIS OPTOMETRY LLC
Entity Type:Organization
Organization Name:TRAVIS OPTOMETRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BALS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:602-320-2601
Mailing Address - Street 1:23233 N PIMA RD STE 115
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-8359
Mailing Address - Country:US
Mailing Address - Phone:602-320-2601
Mailing Address - Fax:
Practice Address - Street 1:23233 N PIMA RD STE 115
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-8359
Practice Address - Country:US
Practice Address - Phone:602-320-2601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-01
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center