Provider Demographics
NPI:1184769028
Name:AFFILIATED OPHTHALMIC SVC
Entity type:Organization
Organization Name:AFFILIATED OPHTHALMIC SVC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:E
Authorized Official - Middle Name:FREDRICK
Authorized Official - Last Name:BLOEMKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-955-5104
Mailing Address - Street 1:3500 E LINCOLN DR # 30
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-1010
Mailing Address - Country:US
Mailing Address - Phone:602-955-5104
Mailing Address - Fax:
Practice Address - Street 1:500 W THOMAS RD
Practice Address - Street 2:SUITE #250
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4224
Practice Address - Country:US
Practice Address - Phone:602-263-9345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CS2496OtherRAILROAD MEDICARE
CS2496OtherRAILROAD MEDICARE