Provider Demographics
NPI:1295710002
Name:SCOTTSDALE EYE SURGERY CENTER, P.C
Entity type:Organization
Organization Name:SCOTTSDALE EYE SURGERY CENTER, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCHWEIKERT
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:480-291-7963
Mailing Address - Street 1:8414 N 90TH ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4395
Mailing Address - Country:US
Mailing Address - Phone:480-949-1208
Mailing Address - Fax:480-994-3316
Practice Address - Street 1:8414 N 90TH ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4395
Practice Address - Country:US
Practice Address - Phone:480-949-1208
Practice Address - Fax:480-994-3316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-14
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOSC0047261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ3C0001063OtherMEDICARE
AZ062688Medicaid