Provider Demographics
NPI:1851730535
Name:PHOENIX RETINA CENTERS, LLC
Entity Type:Organization
Organization Name:PHOENIX RETINA CENTERS, LLC
Other - Org Name:PHOENIX RETINA CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:INGEBORG
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-278-8980
Mailing Address - Street 1:5410 N SCOTTSDALE RD
Mailing Address - Street 2:SUITE A400
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-5927
Mailing Address - Country:US
Mailing Address - Phone:480-278-8980
Mailing Address - Fax:480-990-1147
Practice Address - Street 1:5410 N SCOTTSDALE RD
Practice Address - Street 2:SUITE A400
Practice Address - City:PARADISE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85253-5927
Practice Address - Country:US
Practice Address - Phone:480-278-8980
Practice Address - Fax:480-990-1147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-17
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ37088207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty