Provider Demographics
NPI:1457108565
Name:RETINA AND VISION INSTITUTE OF ARIZONA
Entity Type:Organization
Organization Name:RETINA AND VISION INSTITUTE OF ARIZONA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:KUNIMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-858-3690
Mailing Address - Street 1:2152 S VINEYARD STE 136
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-6882
Mailing Address - Country:US
Mailing Address - Phone:602-858-3690
Mailing Address - Fax:
Practice Address - Street 1:2152 S VINEYARD STE 136
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-6882
Practice Address - Country:US
Practice Address - Phone:602-485-8369
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-06
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty