Provider Demographics
NPI:1285300970
Name:ANTILLON, LUIS ARTURO JR (OD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:ARTURO
Last Name:ANTILLON
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 ENTERPRISE STE 200
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-2626
Mailing Address - Country:US
Mailing Address - Phone:949-688-6205
Mailing Address - Fax:
Practice Address - Street 1:3925 E FORT LOWELL RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-1052
Practice Address - Country:US
Practice Address - Phone:520-576-5110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-21
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOPT-002526152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist