Provider Demographics
NPI:1669532297
Name:EYESWEST OPTICAL, INC.
Entity type:Organization
Organization Name:EYESWEST OPTICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:FINEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-583-0377
Mailing Address - Street 1:12801 W BELL RD
Mailing Address - Street 2:SUITE 139
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85378-9797
Mailing Address - Country:US
Mailing Address - Phone:623-583-0377
Mailing Address - Fax:623-583-0378
Practice Address - Street 1:12801 W BELL RD
Practice Address - Street 2:SUITE 139
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85378-9797
Practice Address - Country:US
Practice Address - Phone:623-583-0377
Practice Address - Fax:623-583-0378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ627332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0460810001Medicare ID - Type Unspecified