Provider Demographics
NPI:1760796270
Name:YAVAPAI ADVANCED VISION CENTER PLLC
Entity Type:Organization
Organization Name:YAVAPAI ADVANCED VISION CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:R
Authorized Official - Last Name:STOTLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:928-717-3259
Mailing Address - Street 1:1727 WILLOW CREEK RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-1154
Mailing Address - Country:US
Mailing Address - Phone:928-717-3259
Mailing Address - Fax:928-778-1023
Practice Address - Street 1:1727 WILLOW CREEK RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1154
Practice Address - Country:US
Practice Address - Phone:928-717-3259
Practice Address - Fax:928-778-1023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-27
Last Update Date:2024-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1604152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty