NPIMap

Organization Active NPI

Elite Optical, LLC

  • Optometrist
  • Mesa, AZ
National Provider Identifier
1477763498
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
641 Issued in AZ
Legal business name
ELITE OPTICAL, LLC
Practice address
1635 N Greenfield Rd
Suite 136
Mesa, AZ 85205-4005
Phone
(480) 219-2412
Fax
(480) 219-2843
NPI assigned
May 22, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Douglas Charles Miner, O.D.NPI 1942255906
Title
President
Phone
(480) 219-2412

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
Optometrist 152W00000X 641 AZ Primary

Addresses

Primary practice location

1635 N Greenfield Rd
Suite 136
Mesa, AZ 85205-4005

Mailing address

1635 N Greenfield Rd
Suite 136
Mesa, AZ 85205-4005
Phone (480) 219-2412

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1179792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1477763498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1635 N GREENFIELD RD",
            "address_2": "SUITE 136",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852054005",
            "telephone_number": "480-219-2412",
            "fax_number": "480-219-2843"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1635 N GREENFIELD RD",
            "address_2": "SUITE 136",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852054005",
            "telephone_number": "480-219-2412",
            "fax_number": "480-219-2843"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE OPTICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MINER",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "CHARLES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "480-219-2412",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AZ",
            "license": "641",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.