Provider Demographics
NPI:1760678320
Name:SAN TAN VILLAGE EYE CARE LLC
Entity Type:Organization
Organization Name:SAN TAN VILLAGE EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:LABROFF
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:480-786-9845
Mailing Address - Street 1:2174 E WILLIAMS FIELD RD
Mailing Address - Street 2:STE 124
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-0745
Mailing Address - Country:US
Mailing Address - Phone:480-786-9845
Mailing Address - Fax:480-786-9843
Practice Address - Street 1:2174 E WILLIAMS FIELD RD
Practice Address - Street 2:STE 124
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-0745
Practice Address - Country:US
Practice Address - Phone:480-786-9845
Practice Address - Fax:480-786-9843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ1515152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty