Provider Demographics
NPI:1881219491
Name:JENNIFER VALENTE CAYWOOD OD LTD
Entity Type:Organization
Organization Name:JENNIFER VALENTE CAYWOOD OD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:VALENTE CAYWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:520-820-8176
Mailing Address - Street 1:10269 E GRAY HAWK DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85730-6115
Mailing Address - Country:US
Mailing Address - Phone:520-820-8176
Mailing Address - Fax:
Practice Address - Street 1:2312 N ROSEMONT BLVD STE 103
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-6114
Practice Address - Country:US
Practice Address - Phone:520-261-2563
Practice Address - Fax:520-263-1269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-09
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ965808Medicaid