Provider Demographics
NPI:1669662789
Name:NORTHWEST VALLEY EYECARE, LLC
Entity Type:Organization
Organization Name:NORTHWEST VALLEY EYECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:TOLAND
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:623-933-2013
Mailing Address - Street 1:10336 W COGGINS DRIVE
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-3438
Mailing Address - Country:US
Mailing Address - Phone:623-933-2013
Mailing Address - Fax:623-933-6652
Practice Address - Street 1:10336 W COGGINS DRIVE
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3438
Practice Address - Country:US
Practice Address - Phone:623-933-2013
Practice Address - Fax:623-933-6652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ949152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ74183Medicare PIN