Provider Demographics
NPI:1841066198
Name:ARROWHEAD OPTOMETRY
Entity type:Organization
Organization Name:ARROWHEAD OPTOMETRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-376-4172
Mailing Address - Street 1:7455 W CREST LN
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310-5623
Mailing Address - Country:US
Mailing Address - Phone:801-376-4172
Mailing Address - Fax:
Practice Address - Street 1:17550 N 79TH AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8711
Practice Address - Country:US
Practice Address - Phone:623-776-4006
Practice Address - Fax:623-776-4048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty