Organization Active NPI

Clasik Vision Care PLLC

  • Optometrist
  • San Tan Valley, AZ
National Provider Identifier
1144567173
Registry record updated Jan 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
791 Issued in AZ
Legal business name
CLASIK VISION CARE PLLC
Practice address
3125 W Hunt Hwy # B-102
San Tan Valley, AZ 85142-9315
Phone
(480) 525-2025
Fax
(480) 422-8749
NPI assigned
Jan 10, 2013
Last updated
Jan 3, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2019

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

Authorized official

Name
Dr. Jordan D Rothlisberger, OD
Title
Doctor/Owner
Phone
(480) 861-0590

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 791 AZ Primary

Addresses

Primary practice location

3125 W Hunt Hwy # B-102
San Tan Valley, AZ 85142-9315

Mailing address

3125 W Hunt Hwy # B-102
San Tan Valley, AZ 85142-9315
Phone (480) 525-2025

Other practice location 1

5537 E Thunderbird Rd
Scottsdale, AZ 85254-3658
Phone (480) 525-2025

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20130311000109 AZ Part B Supplier - Clinic/Group Practice 1153576517 Receives reassigned benefits from 1 practitioner
Practice locations: San Tan Valley, AZ
O20190219001875 AZ Part B Supplier - Clinic/Group Practice 9436497393 Receives reassigned benefits from 3 practitioners
Practice locations: San Tan Valley, AZ

National Provider Directory

National Provider Directory

Locations

3125 W Hunt Hwy
#B102
San Tan Valley, AZ 85144
Phone (480) 525-2025

3125 W Hunt Hwy
Ste B102
San Tan Vly, AZ 85144
Phone (480) 525-2025

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1357776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1546473600000",
    "number": "1144567173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3125 W HUNT HWY # B-102",
            "city": "SAN TAN VALLEY",
            "state": "AZ",
            "postal_code": "851429315",
            "telephone_number": "480-525-2025",
            "fax_number": "480-422-8749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3125 W HUNT HWY # B-102",
            "city": "SAN TAN VALLEY",
            "state": "AZ",
            "postal_code": "851429315",
            "telephone_number": "480-525-2025",
            "fax_number": "480-422-8749"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5537 E Thunderbird Rd",
            "address_purpose": "LOCATION",
            "city": "Scottsdale",
            "state": "AZ",
            "postal_code": "852543658",
            "country_code": "US",
            "telephone_number": "480-525-2025",
            "fax_number": "480-422-8749",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CLASIK VISION CARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-10",
        "last_updated": "2019-01-03",
        "status": "A",
        "authorized_official_last_name": "ROTHLISBERGER",
        "authorized_official_first_name": "JORDAN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "DOCTOR/OWNER",
        "authorized_official_telephone_number": "480-861-0590",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AZ",
            "license": "791",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Tan Valley, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.