Provider Demographics
NPI:1649524729
Name:SALT RIVER EYE CARE, PLLC
Entity type:Organization
Organization Name:SALT RIVER EYE CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MCMULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:724-388-5203
Mailing Address - Street 1:8415 N PIMA RD
Mailing Address - Street 2:SUITE 155
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258
Mailing Address - Country:US
Mailing Address - Phone:480-278-7732
Mailing Address - Fax:480-302-8703
Practice Address - Street 1:8415 N PIMA RD
Practice Address - Street 2:SUITE 155
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258
Practice Address - Country:US
Practice Address - Phone:480-278-7732
Practice Address - Fax:480-302-8703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1584152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty