| NPI | 1275964264 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS ROBERT CZYZ Member/Manager/Owner 602-405-2120 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ 1118) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AZ 1146) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: AZ 1118) | |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: AZ 1146) | |
| 152WP0200X Optometrist, Pediatrics (Licence: AZ 1118) | |
| 152WP0200X Optometrist, Pediatrics (Licence: AZ 1146) | |
| Enumeration Date | 2013-12-02 |
| Last Update Date | 2013-12-02 |