Provider Demographics
NPI:1609040187
Name:JAMES L. ABBOTT, OD, PC
Entity Type:Organization
Organization Name:JAMES L. ABBOTT, OD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:ABBOTT
Authorized Official - Suffix:II
Authorized Official - Credentials:OD
Authorized Official - Phone:480-844-2286
Mailing Address - Street 1:1919 E MCKELLIPS RD
Mailing Address - Street 2:SUTIE 103
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-2844
Mailing Address - Country:US
Mailing Address - Phone:480-844-2286
Mailing Address - Fax:480-610-6641
Practice Address - Street 1:1919 E MCKELLIPS RD
Practice Address - Street 2:SUTIE 103
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-2844
Practice Address - Country:US
Practice Address - Phone:480-844-2286
Practice Address - Fax:480-610-6641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ338152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZT41330Medicare UPIN