Premier Eyecare of Arizona, Inc.
Organization Active NPI Optometrist · Gilbert, AZ
NPI 1114169273 · NPPES record last updated Aug 26, 2009
Key facts
- NPI
- 1114169273
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 1448 (AZ)
- Legal business name
- PREMIER EYECARE OF ARIZONA, INC.
- Practice address
- 3271 E Queen Creek Rd
Ste 107
Gilbert, AZ 85297-8508 - Phone
- (480) 892-3937
- Fax
- (480) 892-3939
- NPI assigned
- Apr 3, 2009
- Organization subpart
- No
Authorized official
- Name
- Dr. Justin Duane Jones, O.D.
- Title
- Member/Manager
- Phone
- (480) 892-3937
Practitioners 6
-
Nainesh C Bhakta, O.D.
-
Daniel Blanco, O.D.
-
Justin Jones, O.D.
-
Darcy Jones, O.D.
-
Kerry Karl Pearson, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090427000593 | AZ | Part B Supplier - Clinic/Group Practice | 8426106618 |
Receives reassigned benefits from 5 practitioners Practice locations: Gilbert, AZ |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 1448 | AZ | Yes |
Addresses
Primary practice location
3271 E Queen Creek Rd
Ste 107
Gilbert, AZ 85297-8508
Mailing address
3271 E Queen Creek Rd
Ste 107
Gilbert, AZ 85297-8508
Phone (480) 892-3937
Other providers in Gilbert, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 26, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.