Provider Demographics
NPI:1720046436
Name:CENTRAL ARIZONA EYE CLINIC P.C.
Entity Type:Organization
Organization Name:CENTRAL ARIZONA EYE CLINIC P.C.
Other - Org Name:RUMMEL OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:RUMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-445-1341
Mailing Address - Street 1:1022 WILLOW CREEK RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-1607
Mailing Address - Country:US
Mailing Address - Phone:928-445-4069
Mailing Address - Fax:928-778-5550
Practice Address - Street 1:1022 WILLOW CREEK RD
Practice Address - Street 2:SUITE 200
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1607
Practice Address - Country:US
Practice Address - Phone:928-445-4069
Practice Address - Fax:928-778-5550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ193588332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ305583Medicaid
0381170001Medicare NSC
AZ30558302Medicaid
AZ30558301Medicaid