Provider Demographics
NPI:1982268298
Name:EYE DOCTORS OF ARIZONA PLLC
Entity Type:Organization
Organization Name:EYE DOCTORS OF ARIZONA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:602-257-8280
Mailing Address - Street 1:515 W BUCKEYE RD STE 104
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85003-3699
Mailing Address - Country:US
Mailing Address - Phone:602-257-8280
Mailing Address - Fax:602-257-7007
Practice Address - Street 1:515 W BUCKEYE RD STE 104
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85003-3699
Practice Address - Country:US
Practice Address - Phone:602-257-8280
Practice Address - Fax:602-257-7007
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYE DOCTORS OF ARIZONA PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-23
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ422367Medicaid