Provider Demographics
NPI:1700823051
Name:RETINAL CONSULTANTS OF ARIZONA LTD
Entity Type:Organization
Organization Name:RETINAL CONSULTANTS OF ARIZONA LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMIESON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-640-6442
Mailing Address - Street 1:PO BOX 32530
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85064-2530
Mailing Address - Country:US
Mailing Address - Phone:602-265-2695
Mailing Address - Fax:602-265-5077
Practice Address - Street 1:1101 E MISSOURI AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2709
Practice Address - Country:US
Practice Address - Phone:602-222-2221
Practice Address - Fax:602-265-5077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZWCLCGMedicare ID - Type Unspecified