Provider Demographics
NPI:1972774172
Name:AGAVE EYE CARE, PLLC
Entity Type:Organization
Organization Name:AGAVE EYE CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:NAN YIN
Authorized Official - Last Name:LIAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-895-2020
Mailing Address - Street 1:1815 E QUEEN CREEK RD
Mailing Address - Street 2:STE # 2
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-2017
Mailing Address - Country:US
Mailing Address - Phone:480-895-2020
Mailing Address - Fax:
Practice Address - Street 1:1815 E QUEEN CREEK RD
Practice Address - Street 2:STE # 2
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-2017
Practice Address - Country:US
Practice Address - Phone:480-895-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1010152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty