Provider Demographics
NPI:1538361282
Name:EYE CARE AT THE PROMENADE
Entity type:Organization
Organization Name:EYE CARE AT THE PROMENADE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:REITANO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:480-732-9040
Mailing Address - Street 1:2860 S ALMA SCHOOL RD
Mailing Address - Street 2:SUITE 28
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-8118
Mailing Address - Country:US
Mailing Address - Phone:480-732-9040
Mailing Address - Fax:480-782-9519
Practice Address - Street 1:2860 S ALMA SCHOOL RD
Practice Address - Street 2:SUITE 28
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-8118
Practice Address - Country:US
Practice Address - Phone:480-732-9040
Practice Address - Fax:480-782-9519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ928152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty