Provider Demographics
NPI:1770797631
Name:HODGES EYE CARE & SURGICAL CENTER, INC.
Entity type:Organization
Organization Name:HODGES EYE CARE & SURGICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:DR
Authorized Official - Phone:520-326-4321
Mailing Address - Street 1:1502 N. TUCSON BLVD.
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716
Mailing Address - Country:US
Mailing Address - Phone:520-326-4321
Mailing Address - Fax:520-326-4736
Practice Address - Street 1:1502 N. TUCSON BLVD.
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716
Practice Address - Country:US
Practice Address - Phone:520-326-4321
Practice Address - Fax:520-326-4736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31263174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ76558Medicare PIN
Z76558Medicare PIN
AZZ76558Medicare UPIN