Provider Demographics
NPI:1356377873
Name:PHOENIX OPHTHALMOLOGISTS PA
Entity type:Organization
Organization Name:PHOENIX OPHTHALMOLOGISTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:VANBUREN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-995-1166
Mailing Address - Street 1:1130 E MISSOURI AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-2712
Mailing Address - Country:US
Mailing Address - Phone:602-995-1166
Mailing Address - Fax:602-995-2390
Practice Address - Street 1:1130 E MISSOURI AVE STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2712
Practice Address - Country:US
Practice Address - Phone:602-995-1166
Practice Address - Fax:602-995-1166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ41479207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty