Provider Demographics
NPI:1538257753
Name:ARIZONA GLAUCOMA SPECIALISTS PC
Entity type:Organization
Organization Name:ARIZONA GLAUCOMA SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:MOUNTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-396-9339
Mailing Address - Street 1:PO BOX 36988
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85740-6988
Mailing Address - Country:US
Mailing Address - Phone:520-544-4393
Mailing Address - Fax:520-544-0098
Practice Address - Street 1:6599 N ORACLE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-5606
Practice Address - Country:US
Practice Address - Phone:520-544-4393
Practice Address - Fax:520-544-0098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16920207W00000X, 207WX0009X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma SpecialistGroup - Single Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZWCLFVMedicare PIN