Provider Demographics
NPI:1932311081
Name:MATHIS EYE CARE LLC
Entity Type:Organization
Organization Name:MATHIS EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ARNOLD
Authorized Official - Last Name:MATHIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:928-300-9059
Mailing Address - Street 1:3600 W. FAIRWAY CIR.
Mailing Address - Street 2:
Mailing Address - City:CORNVILLE
Mailing Address - State:AZ
Mailing Address - Zip Code:86325
Mailing Address - Country:US
Mailing Address - Phone:928-300-9059
Mailing Address - Fax:928-634-4532
Practice Address - Street 1:2003 E. RODEO DR.
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326
Practice Address - Country:US
Practice Address - Phone:928-634-4530
Practice Address - Fax:928-634-4532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1409152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ101092Medicare PIN