Provider Demographics
NPI:1629188479
Name:2020 IMAGE TEMPE
Entity Type:Organization
Organization Name:2020 IMAGE TEMPE
Other - Org Name:EYECARE CONSULTANTS PLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MYDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-967-5710
Mailing Address - Street 1:307 E SOUTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282
Mailing Address - Country:US
Mailing Address - Phone:480-967-5710
Mailing Address - Fax:480-967-2845
Practice Address - Street 1:307 E SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282
Practice Address - Country:US
Practice Address - Phone:480-967-5710
Practice Address - Fax:480-967-2845
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYECARE CONSULTANTS PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-30
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZWDBTZMedicare PIN