Provider Demographics
NPI:1639723471
Name:EYE CARE FOR KIDS ARIZONA CHAPTER INC
Entity Type:Organization
Organization Name:EYE CARE FOR KIDS ARIZONA CHAPTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:G
Authorized Official - Last Name:CARBONE
Authorized Official - Suffix:
Authorized Official - Credentials:ABOC, NCLC
Authorized Official - Phone:801-285-5443
Mailing Address - Street 1:6911 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-1239
Mailing Address - Country:US
Mailing Address - Phone:801-285-5443
Mailing Address - Fax:801-255-8526
Practice Address - Street 1:6615 N 39TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85019-1334
Practice Address - Country:US
Practice Address - Phone:801-285-5443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYE CARE FOR KIDS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact LensGroup - Multi-Specialty
No156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens FitterGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty