Provider Demographics
NPI:1669623682
Name:DESERT LOW VISION SERVICES, LLC
Entity type:Organization
Organization Name:DESERT LOW VISION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DYLLA
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:520-881-3439
Mailing Address - Street 1:1645 N ALVERNON WAY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-3353
Mailing Address - Country:US
Mailing Address - Phone:520-881-3439
Mailing Address - Fax:520-881-3482
Practice Address - Street 1:1645 N ALVERNON WAY
Practice Address - Street 2:SUITE 2
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-3353
Practice Address - Country:US
Practice Address - Phone:520-881-3439
Practice Address - Fax:520-881-3482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10187536-J332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment