Arizona Oculofacial Plastic Orbit and Cosmetic Surgery, LLC

Primary specialty

Ophthalmologic Surgery Clinic/CenterTaxonomy code 261QS0132X

Legal business name

ARIZONA OCULOFACIAL PLASTIC ORBIT AND COSMETIC SURGERY, LLC

Doing business as

Arizona
Arizona Oculofacial Plastic Orbit and Cosmetic Surgery LLC

Practice address

1055 S Stapley Dr
Mesa, AZ 85204-5013

Phone

(480) 892-8400

Fax

(480) 892-1889

NPI assigned

Jan 14, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

David Soto

Title

Credentialing Manager

Phone

(480) 822-6230

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 2

• Arizona Doing business as
• Arizona Oculofacial Plastic Orbit and Cosmetic Surgery LLC Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1547424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1547424000000",
    "number": "1013481977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 40085",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852740085",
            "telephone_number": "323-533-4452",
            "fax_number": "480-994-9479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1055 S STAPLEY DR",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852045013",
            "telephone_number": "480-892-8400",
            "fax_number": "480-892-1889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARIZONA OCULOFACIAL PLASTIC ORBIT AND COSMETIC SURGERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-14",
        "last_updated": "2019-01-14",
        "status": "A",
        "authorized_official_last_name": "SOTO",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "480-822-6230"
    },
    "taxonomies": [
        {
            "code": "261QS0132X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ophthalmologic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "247118",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Arizona",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Arizona Oculofacial Plastic Orbit and Cosmetic Surgery LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Arizona Mobile Imaging LLC
• Arizona Mobile Imaging LLC
• Arizona Nevada Visiting Nurses
• Arizona Non-Medical Transportation
• Arizona Occupational Medical Clinics
• Arizona on Call Health
• Arizona Ophthalmology Specialists, PLC
• Arizona Orthopedic & Sports Medicine Associates Inc
• Arizona Pain and Spine Institute PLLC
• Arizona Pain Management Specialists

• Ophthalmologic Surgery Clinic/Center in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Ophthalmologic Surgery Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.