Provider Demographics
NPI:1942324561
Name:FAMILY EYECARE ASSOCIATES OF AZ PLC
Entity Type:Organization
Organization Name:FAMILY EYECARE ASSOCIATES OF AZ PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:G
Authorized Official - Last Name:BARK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:480-419-3900
Mailing Address - Street 1:6120 W BELL RD
Mailing Address - Street 2:# 130
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-3781
Mailing Address - Country:US
Mailing Address - Phone:602-843-2900
Mailing Address - Fax:602-843-0233
Practice Address - Street 1:6120 W BELL RD
Practice Address - Street 2:# 130
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-3781
Practice Address - Country:US
Practice Address - Phone:602-843-2900
Practice Address - Fax:602-843-0233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ4961130002Medicare NSC
AZZ70121Medicare PIN