Provider Demographics
NPI:1851719538
Name:TOTAL EYECARE CENTERS, PLLC
Entity Type:Organization
Organization Name:TOTAL EYECARE CENTERS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:602-508-4843
Mailing Address - Street 1:4800 N 22ND ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4701
Mailing Address - Country:US
Mailing Address - Phone:602-508-4843
Mailing Address - Fax:602-508-4830
Practice Address - Street 1:11230 N TATUM BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-1663
Practice Address - Country:US
Practice Address - Phone:602-508-4843
Practice Address - Fax:602-508-4830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-31
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty