Provider Demographics
NPI:1740431378
Name:PRESCOTT EYE CARE & SURGICAL CENTER, PC
Entity Type:Organization
Organization Name:PRESCOTT EYE CARE & SURGICAL CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:W
Authorized Official - Last Name:MORTENSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-445-9200
Mailing Address - Street 1:3192 WILLOW CREEK RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-6610
Mailing Address - Country:US
Mailing Address - Phone:928-445-1234
Mailing Address - Fax:928-772-8107
Practice Address - Street 1:3769 CROSSING DRIVE
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-1606
Practice Address - Country:US
Practice Address - Phone:928-445-9200
Practice Address - Fax:928-772-8107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-01
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmicGroup - Multi-Specialty