Provider Demographics
NPI:1952375099
Name:DESERT VISTA EYEWEAR
Entity Type:Organization
Organization Name:DESERT VISTA EYEWEAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:R
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:EASON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-507-0600
Mailing Address - Street 1:2450 E GUADALUPE RD
Mailing Address - Street 2:STE 107
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-5116
Mailing Address - Country:US
Mailing Address - Phone:480-507-0600
Mailing Address - Fax:480-558-7162
Practice Address - Street 1:2450 E GUADALUPE RD
Practice Address - Street 2:STE 107
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-5116
Practice Address - Country:US
Practice Address - Phone:480-507-0600
Practice Address - Fax:480-558-7162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207W00000X
AZ332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ4318140002Medicare NSC