Provider Demographics
NPI:1457410623
Name:ABC CHILDREN'S EYE SPECIALISTS PC
Entity type:Organization
Organization Name:ABC CHILDREN'S EYE SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP PRACTICE DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:REITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-222-2234
Mailing Address - Street 1:PO BOX 97876
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85060
Mailing Address - Country:US
Mailing Address - Phone:602-222-2234
Mailing Address - Fax:602-222-3025
Practice Address - Street 1:14418 W MEEKER BLVD
Practice Address - Street 2:STE 101
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85375-5290
Practice Address - Country:US
Practice Address - Phone:602-222-2234
Practice Address - Fax:866-985-7247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ71905Medicare ID - Type Unspecified