Provider Demographics
NPI:1184962805
Name:COMP VISION CARE, PLLC
Entity type:Organization
Organization Name:COMP VISION CARE, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:T
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:520-300-6233
Mailing Address - Street 1:6383 E GRANT RD
Mailing Address - Street 2:SUITE 135
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-3826
Mailing Address - Country:US
Mailing Address - Phone:520-300-6233
Mailing Address - Fax:520-300-6349
Practice Address - Street 1:6383 E GRANT RD
Practice Address - Street 2:SUITE 135
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-3826
Practice Address - Country:US
Practice Address - Phone:520-300-6233
Practice Address - Fax:520-300-6349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-30
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1265152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ984189Medicaid
AZV06231Medicare UPIN
AZ984189Medicaid