Provider Demographics
NPI:1578841250
Name:HELLAN, ASINECH (OD)
Entity Type:Individual
Prefix:
First Name:ASINECH
Middle Name:
Last Name:HELLAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ASINECH
Other - Middle Name:
Other - Last Name:MIDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:17394 W MOHAVE ST
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-1712
Mailing Address - Country:US
Mailing Address - Phone:954-296-4194
Mailing Address - Fax:
Practice Address - Street 1:3425 W PEORIA AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4606
Practice Address - Country:US
Practice Address - Phone:602-504-2720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-28
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1821152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist