Provider Demographics
NPI:1548465248
Name:ARIZONA OCULAR PROSTHETICS, LLC
Entity type:Organization
Organization Name:ARIZONA OCULAR PROSTHETICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES/OCULARIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:BCO
Authorized Official - Phone:480-264-3041
Mailing Address - Street 1:3025 S KENNETH PL
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-3942
Mailing Address - Country:US
Mailing Address - Phone:480-264-3041
Mailing Address - Fax:
Practice Address - Street 1:3025 S KENNETH PL
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-3942
Practice Address - Country:US
Practice Address - Phone:480-264-3041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100020070BMedicaid
IL363611105001Medicaid
IN0352110002Medicare ID - Type Unspecified
IL0352110001Medicare ID - Type Unspecified