Provider Demographics
NPI:1750551107
Name:ESTRELLA EYECARE
Entity type:Organization
Organization Name:ESTRELLA EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:FRANK
Authorized Official - Suffix:III
Authorized Official - Credentials:OD
Authorized Official - Phone:623-845-1400
Mailing Address - Street 1:13065 W MCDOWELL RD
Mailing Address - Street 2:SUITE B-105
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-6439
Mailing Address - Country:US
Mailing Address - Phone:623-845-1400
Mailing Address - Fax:623-845-1401
Practice Address - Street 1:13065 W MCDOWELL RD
Practice Address - Street 2:SUITE B-105
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-6439
Practice Address - Country:US
Practice Address - Phone:623-845-1400
Practice Address - Fax:623-845-1401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-01
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ00588152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ130955Medicare PIN