Provider Demographics
NPI:1023238458
Name:PRESCOTT VALLEY EYE CARE PC
Entity type:Organization
Organization Name:PRESCOTT VALLEY EYE CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:COURTRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:928-771-9939
Mailing Address - Street 1:3153 N WINDSONG DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-2240
Mailing Address - Country:US
Mailing Address - Phone:928-771-9939
Mailing Address - Fax:928-772-3972
Practice Address - Street 1:3153 N WINDSONG DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-2240
Practice Address - Country:US
Practice Address - Phone:928-771-9939
Practice Address - Fax:928-772-3972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ909152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0903430OtherBCBS OF AZ
AZZ73802Medicare PIN
AZ410049678Medicare ID - Type UnspecifiedRAILROAD MEDICARE
AZ4844460001Medicare ID - Type UnspecifiedDURABLE MEDICAL EQUIPMENT