Provider Demographics
NPI:1861676934
Name:SOUTHWESTERN GLAUCOMA CONSULTANTS
Entity Type:Organization
Organization Name:SOUTHWESTERN GLAUCOMA CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:BATKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-933-0176
Mailing Address - Street 1:10615 W THUNDERBIRD BLVD
Mailing Address - Street 2:B300 SOUTHWESTERN GLAUCOMA CONSULTANTS LTD
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351
Mailing Address - Country:US
Mailing Address - Phone:623-933-0176
Mailing Address - Fax:623-933-2808
Practice Address - Street 1:10615 W THUNDERBIRD BLVD
Practice Address - Street 2:B300
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351
Practice Address - Country:US
Practice Address - Phone:623-933-0176
Practice Address - Fax:623-933-2808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11931207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZCS5659OtherRAILROAD
AZ234162Medicaid
AZCS5659OtherRAILROAD
AZC99103Medicare UPIN