Provider Demographics
NPI:1780855668
Name:NORTHLAND EYE CARE PC
Entity Type:Organization
Organization Name:NORTHLAND EYE CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:M
Authorized Official - Last Name:HIPSHER
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:928-226-9300
Mailing Address - Street 1:2050 S WOODLANDS VILLAGE BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-2972
Mailing Address - Country:US
Mailing Address - Phone:928-226-9300
Mailing Address - Fax:928-226-8651
Practice Address - Street 1:2050 S WOODLANDS VILLAGE BLVD STE 3
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-2972
Practice Address - Country:US
Practice Address - Phone:928-226-9300
Practice Address - Fax:928-226-8651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ1203332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ163766Medicare PIN
AZU61402Medicare UPIN
AZ6043120001Medicare NSC