NPIMap

Organization Active NPI

Active Eyecare LLC

Doing business as Active Eyecare of Surprise

  • Clinic/Center
  • Surprise, AZ
National Provider Identifier
1295100204
Registry record updated Dec 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
1117 Issued in AZ
Legal business name
ACTIVE EYECARE LLC
Doing business as
Active Eyecare of Surprise
Practice address
16968 W Bell Rd
Suite 402
Surprise, AZ 85374-8943
Phone
(623) 214-0353
Fax
(623) 214-0693
NPI assigned
Dec 2, 2015
Last updated
Dec 2, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2015

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

Authorized official

Name
Dr. Mark Edward Fechtel, ODNPI 1356338636
Title
Owner
Phone
(623) 214-0353

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 1117 AZ Primary

Addresses

Primary practice location

16968 W Bell Rd
Suite 402
Surprise, AZ 85374-8943

Mailing address

16968 W Bell Rd
Suite 402
Surprise, AZ 85374-8943
Phone (623) 214-0353

Other names 1

  • Active Eyecare of Surprise Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171212000108 AZ Part B Supplier - Clinic/Group Practice 8426316993 Practice locations: Surprise, AZ

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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": "1449014400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449014400000",
    "number": "1295100204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16968 W BELL RD",
            "address_2": "SUITE 402",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853748943",
            "telephone_number": "623-214-0353",
            "fax_number": "623-214-0693"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16968 W BELL RD",
            "address_2": "SUITE 402",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853748943",
            "telephone_number": "623-214-0353",
            "fax_number": "623-214-0693"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE EYECARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-02",
        "last_updated": "2015-12-02",
        "status": "A",
        "authorized_official_last_name": "FECHTEL",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "623-214-0353",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "AZ",
            "license": "1117",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Active Eyecare of Surprise",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Surprise, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2015; 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.