Provider Demographics
NPI:1598701013
Name:SURPRISE OPTOMETRIC CARE
Entity Type:Organization
Organization Name:SURPRISE OPTOMETRIC CARE
Other - Org Name:SURPRISE EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:ORNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:623-533-4697
Mailing Address - Street 1:15033 W BELL RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-3217
Mailing Address - Country:US
Mailing Address - Phone:623-533-4697
Mailing Address - Fax:623-533-4709
Practice Address - Street 1:15033 W BELL RD
Practice Address - Street 2:SUITE 150
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-3217
Practice Address - Country:US
Practice Address - Phone:623-533-4697
Practice Address - Fax:623-533-4709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1192152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ110040Medicare PIN
AZU83721Medicare UPIN
AZ5980420001Medicare NSC