Provider Demographics
NPI:1720125156
Name:SCOTTSDALE EYE INSTITUTE, PLC
Entity Type:Organization
Organization Name:SCOTTSDALE EYE INSTITUTE, PLC
Other - Org Name:SCOTTSDALE EYE INSTITUTE, PLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TARIQ
Authorized Official - Middle Name:
Authorized Official - Last Name:QAMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-981-1345
Mailing Address - Street 1:215 S POWER RD STE 112
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-5236
Mailing Address - Country:US
Mailing Address - Phone:480-981-1345
Mailing Address - Fax:480-981-3721
Practice Address - Street 1:215 S POWER RD STE 112
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-5236
Practice Address - Country:US
Practice Address - Phone:480-981-1345
Practice Address - Fax:480-981-3721
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SCOTTSDALE EYE INSTITUTE, PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-01
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOSC 3901261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ108319OtherPTAN Z108319
AZP00283401Medicare PIN