Provider Demographics
NPI:1790972388
Name:YUMA VISION CENTER, INC
Entity Type:Organization
Organization Name:YUMA VISION CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF OPTOMETRY
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:FRANCES
Authorized Official - Last Name:DETERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:928-782-7557
Mailing Address - Street 1:2750 S PACIFIC AVE STE D
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-3547
Mailing Address - Country:US
Mailing Address - Phone:928-782-7557
Mailing Address - Fax:928-783-8445
Practice Address - Street 1:2750 S PACIFIC AVE STE D
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365-3547
Practice Address - Country:US
Practice Address - Phone:928-782-7557
Practice Address - Fax:928-783-8445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ786152W00000X
AZ663152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ104927Medicaid
AZ074667Medicaid
AZT87215Medicare UPIN
AZ074667Medicaid
AZ1315330001Medicare NSC