Provider Demographics
NPI:1639108335
Name:ARIZONA FOUNDATION FOR THE CHANGING EYE, INC.
Entity Type:Organization
Organization Name:ARIZONA FOUNDATION FOR THE CHANGING EYE, INC.
Other - Org Name:ARIZONA FOUNDATION FOR EYE HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ABAGAIL
Authorized Official - Middle Name:B
Authorized Official - Last Name:GUIVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-251-3400
Mailing Address - Street 1:4020 N 20TH ST
Mailing Address - Street 2:STE 215
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-6028
Mailing Address - Country:US
Mailing Address - Phone:602-251-3400
Mailing Address - Fax:602-466-1150
Practice Address - Street 1:4020 N 20TH ST
Practice Address - Street 2:STE 215
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-6028
Practice Address - Country:US
Practice Address - Phone:602-251-3400
Practice Address - Fax:602-466-1150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ749077Medicaid
AZZ144058Medicare PIN