Provider Demographics
NPI:1780605808
Name:CORNEA & CATARACT CONSULTANTS OF ARIZONA PC
Entity type:Organization
Organization Name:CORNEA & CATARACT CONSULTANTS OF ARIZONA PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:HOLLIS
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-258-4321
Mailing Address - Street 1:3815 E BELL RD
Mailing Address - Street 2:SUITE 2500
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2122
Mailing Address - Country:US
Mailing Address - Phone:602-258-4321
Mailing Address - Fax:602-253-5917
Practice Address - Street 1:3815 E BELL RD
Practice Address - Street 2:SUITE 2500
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2122
Practice Address - Country:US
Practice Address - Phone:602-258-4321
Practice Address - Fax:602-253-5917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24084207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZH32150Medicare UPIN
AZI40881Medicare UPIN
AZG16965Medicare UPIN
AZZWCHYMMedicare Oscar/Certification