Provider Demographics
NPI:1982901922
Name:DAVE CLINE OD PC
Entity Type:Organization
Organization Name:DAVE CLINE OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:CLINE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:602-870-0251
Mailing Address - Street 1:10001 N METRO PKWY W
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-1405
Mailing Address - Country:US
Mailing Address - Phone:602-870-0251
Mailing Address - Fax:
Practice Address - Street 1:10001 N METRO PKWY W
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-1405
Practice Address - Country:US
Practice Address - Phone:602-870-0251
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-25
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ476152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty