Provider Demographics
NPI:1598750713
Name:SCOTTSDALE EYE PHYSICIANS & SURGEONS PC
Entity Type:Organization
Organization Name:SCOTTSDALE EYE PHYSICIANS & SURGEONS PC
Other - Org Name:DR WILLIAM KILPATRICK AND DR DENNIS KILPATRICK
Other - Org Type:Other Name
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANTA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRACY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-994-1872
Mailing Address - Street 1:7550 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-4504
Mailing Address - Country:US
Mailing Address - Phone:480-994-1872
Mailing Address - Fax:480-994-0130
Practice Address - Street 1:7550 E 2ND ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-4504
Practice Address - Country:US
Practice Address - Phone:480-994-1872
Practice Address - Fax:480-994-0130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-14
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8488207W00000X
AZ13541207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZC99759Medicare UPIN
AZD44118Medicare UPIN
AZ0302560001Medicare NSC