Provider Demographics
NPI:1912149998
Name:CL EYE CARE, PLLC
Entity Type:Organization
Organization Name:CL EYE CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:P
Authorized Official - Last Name:MARMO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:602-910-0069
Mailing Address - Street 1:1104 W LYDIA LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85041-5924
Mailing Address - Country:US
Mailing Address - Phone:602-910-0069
Mailing Address - Fax:
Practice Address - Street 1:10615 W THUNDERBIRD BLVD
Practice Address - Street 2:SUITE D-500
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3033
Practice Address - Country:US
Practice Address - Phone:602-910-0069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1437152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZT77692Medicare UPIN