Provider Demographics
NPI:1598808636
Name:EAST VALLEY OPHTHALMOLOGY, LTD
Entity Type:Organization
Organization Name:EAST VALLEY OPHTHALMOLOGY, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:E
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-981-6111
Mailing Address - Street 1:5620 E BROADWAY RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-1438
Mailing Address - Country:US
Mailing Address - Phone:480-981-6111
Mailing Address - Fax:480-985-2426
Practice Address - Street 1:5620 E BROADWAY RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-1438
Practice Address - Country:US
Practice Address - Phone:480-981-6111
Practice Address - Fax:480-985-2426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12866207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ28195701Medicaid
AZ0386310OtherHILL BCBS NUMBER
AZ39600304Medicaid
AZ0887960OtherNIRENBERG BCBS NUMBER
AZ0887960OtherNIRENBERG BCBS NUMBER
AZC31724Medicare UPIN
AZCN9576Medicare ID - Type UnspecifiedRR MEDICARE GROUP NUMBER
AZ28195701Medicaid
AZD64003Medicare UPIN