Provider Demographics
NPI:1609106145
Name:BARNET DULANEY PERKINS EYE CENTER
Entity Type:Organization
Organization Name:BARNET DULANEY PERKINS EYE CENTER
Other - Org Name:BARNET DULANEY PERKINS EYE CENTER SHOW LOW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:D
Authorized Official - Last Name:BROOKFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-598-7488
Mailing Address - Street 1:63 S ROCKFORD DR STE 220
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85288-6226
Mailing Address - Country:US
Mailing Address - Phone:602-598-7488
Mailing Address - Fax:602-508-4830
Practice Address - Street 1:1500 S WHITE MOUNTAIN RD
Practice Address - Street 2:SUITE 300
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-7111
Practice Address - Country:US
Practice Address - Phone:928-537-3937
Practice Address - Fax:928-537-4729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-06
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ858152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ576689Medicaid