Provider Demographics
NPI:1912277682
Name:JAN M MCVEY OD PC
Entity Type:Organization
Organization Name:JAN M MCVEY OD PC
Other - Org Name:DR. JAN M MCVEY O D
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/ DOCTOR/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCVEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:623-937-5121
Mailing Address - Street 1:5334 W NORTHERN AVE
Mailing Address - Street 2:SUITE #106
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85301-1441
Mailing Address - Country:US
Mailing Address - Phone:623-937-5121
Mailing Address - Fax:623-937-3432
Practice Address - Street 1:5334 W NORTHERN AVE
Practice Address - Street 2:SUITE #106
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-1441
Practice Address - Country:US
Practice Address - Phone:623-937-5121
Practice Address - Fax:623-937-3432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-11
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ152152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZT41940Medicare UPIN
6676250001Medicare NSC