Provider Demographics
NPI:1952997470
Name:PRIMERA ENTERPRISE LLC
Entity Type:Organization
Organization Name:PRIMERA ENTERPRISE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MAYRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MACHUCA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-877-2481
Mailing Address - Street 1:2950 N 91ST AVE STE C-102
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-3380
Mailing Address - Country:US
Mailing Address - Phone:623-877-2481
Mailing Address - Fax:
Practice Address - Street 1:2950 N 91ST AVE STE C-102
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-3380
Practice Address - Country:US
Practice Address - Phone:623-877-2481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty