Provider Demographics
NPI:1689893711
Name:OCULOPLASTIC CONSULTANTS OF ARIZONA P C
Entity Type:Organization
Organization Name:OCULOPLASTIC CONSULTANTS OF ARIZONA P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-993-9100
Mailing Address - Street 1:20100 N 51ST AVE
Mailing Address - Street 2:SUITE E-570
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-5125
Mailing Address - Country:US
Mailing Address - Phone:602-993-9100
Mailing Address - Fax:
Practice Address - Street 1:20100 N 51ST AVE
Practice Address - Street 2:SUITE E-570
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-5125
Practice Address - Country:US
Practice Address - Phone:602-993-9100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ25627174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ393645Medicaid
AZ77316Medicare ID - Type Unspecified
AZ393645Medicaid