Provider Demographics
NPI: | 1952879678 |
---|---|
Name: | SOUTHWESTERN EYE CENTER, LTD |
Entity Type: | Organization |
Organization Name: | SOUTHWESTERN EYE CENTER, LTD |
Other - Org Name: | SOUTHWESTERN EYE CENTER - MAIN ST OPTICAL |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CHIEF FINANCIAL OFFICER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ARTHUR |
Authorized Official - Middle Name: | D |
Authorized Official - Last Name: | BROOKFIELD |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 602-598-7488 |
Mailing Address - Street 1: | 63 S ROCKFORD DR STE 220 |
Mailing Address - Street 2: | |
Mailing Address - City: | TEMPE |
Mailing Address - State: | AZ |
Mailing Address - Zip Code: | 85288-6226 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 602-598-7488 |
Mailing Address - Fax: | 602-231-6215 |
Practice Address - Street 1: | 7435 E MAIN ST STE 101 |
Practice Address - Street 2: | |
Practice Address - City: | MESA |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 85207-8337 |
Practice Address - Country: | US |
Practice Address - Phone: | 480-834-3777 |
Practice Address - Fax: | 480-832-2771 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2018-11-12 |
Last Update Date: | 2024-01-17 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 332B00000X | Suppliers | Durable Medical Equipment & Medical Supplies |