Provider Demographics
NPI:1578749370
Name:EYES ON FOUNTAIN HILLS P.C.
Entity Type:Organization
Organization Name:EYES ON FOUNTAIN HILLS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:480-837-2020
Mailing Address - Street 1:16425 E PALISADES BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-3754
Mailing Address - Country:US
Mailing Address - Phone:480-837-2020
Mailing Address - Fax:480-836-9758
Practice Address - Street 1:16425 E PALISADES BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-3754
Practice Address - Country:US
Practice Address - Phone:480-837-2020
Practice Address - Fax:480-836-9758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ6004610002Medicare NSC
Z72540Medicare PIN
DR9888Medicare PIN