Provider Demographics
NPI:1659515484
Name:EYE CARE CLINIC P.C.
Entity Type:Organization
Organization Name:EYE CARE CLINIC P.C.
Other - Org Name:VAL VISTA VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:COOLEY STALEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:480-813-7050
Mailing Address - Street 1:1400 N GILBERT RD
Mailing Address - Street 2:STE I
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234
Mailing Address - Country:US
Mailing Address - Phone:480-813-7050
Mailing Address - Fax:480-813-3630
Practice Address - Street 1:1780 E BOSTON ST STE 101
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-6246
Practice Address - Country:US
Practice Address - Phone:480-813-7050
Practice Address - Fax:480-813-3630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-23
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ882152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU45313Medicare UPIN