Provider Demographics
NPI:1265649008
Name:DESERT OASIS EYE CARE & OPTICAL
Entity type:Organization
Organization Name:DESERT OASIS EYE CARE & OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:PAROT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:623-412-8484
Mailing Address - Street 1:15256 N 75TH AVE
Mailing Address - Street 2:SUITE 380
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4760
Mailing Address - Country:US
Mailing Address - Phone:623-412-8484
Mailing Address - Fax:
Practice Address - Street 1:15256 N 75TH AVE
Practice Address - Street 2:SUITE 380
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4760
Practice Address - Country:US
Practice Address - Phone:623-412-8484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ848152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ78984Medicare PIN
AZ5544470001Medicare NSC