Vision 21 Managed Eye Care of Tampa Bay, Inc

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

License

94171 Issued in AZ

Legal business name

VISION 21 MANAGED EYE CARE OF TAMPA BAY, INC

Doing business as

Eye Specialists

Practice address

3033 N 44TH St
Ste 270
Phoenix, AZ 85018-7226

Phone

(602) 912-9393

Fax

(602) 381-8994

NPI assigned

Dec 10, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Mark Dalton

Title

President

Phone

(602) 912-9393

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Eye Specialists Doing business as

Locations

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

{
    "created_epoch": "1197244800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1197244800000",
    "number": "1477736700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3033 N 44TH ST",
            "address_2": "STE 270",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850187226",
            "telephone_number": "602-912-9393",
            "fax_number": "602-381-8994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3033 N 44TH ST",
            "address_2": "STE 270",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850187226",
            "telephone_number": "602-912-9393",
            "fax_number": "602-381-8994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VISION 21 MANAGED EYE CARE OF TAMPA BAY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-10",
        "last_updated": "2007-12-10",
        "status": "A",
        "authorized_official_last_name": "DALTON",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "602-912-9393",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "AZ",
            "license": "94171",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "469280",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eye Specialists",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Exclusive Provider Organization in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Exclusive Provider Organization in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2007; 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.