NPIMap

Organization Active NPI

Eye Care Clinic P.C.

  • Optometrist
  • Gilbert, AZ
National Provider Identifier
1659515484
Registry record updated Aug 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
882 Issued in AZ
Legal business name
EYE CARE CLINIC P.C.
Practice address
1780 E Boston St Ste 101
Gilbert, AZ 85295-6246
Phone
(480) 813-7050
Fax
(480) 813-3630
NPI assigned
Apr 23, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2021

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

Authorized official

Name
Mrs. Tina Cooley Staley, O.D.NPI 1114062668
Title
Owner/Optometrist
Phone
(480) 813-7050

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 882 AZ Primary

Addresses

Primary practice location

1780 E Boston St Ste 101
Gilbert, AZ 85295-6246

Mailing address

1400 N Gilbert Rd
Ste I
Gilbert, AZ 85234
Phone (480) 813-7050

Other names 1

  • Val Vista Vision Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090925000243 AZ Part B Supplier - Clinic/Group Practice 6608868229 Receives reassigned benefits from 3 practitioners
Practice locations: Gilbert, AZ

National Provider Directory

National Provider Directory

Locations

1400 N Gilbert Rd
Ste I
Gilbert, AZ 85234
Phone (480) 539-2808

1780 E Boston St
Gilbert, AZ 85295

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1240444800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629849600000",
    "number": "1659515484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 N GILBERT RD",
            "address_2": "STE I",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "85234",
            "telephone_number": "480-813-7050",
            "fax_number": "480-813-3630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1780 E BOSTON ST STE 101",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852956246",
            "telephone_number": "480-813-7050",
            "fax_number": "480-813-3630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE CARE CLINIC P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-23",
        "last_updated": "2021-08-25",
        "certification_date": "2021-08-25",
        "status": "A",
        "authorized_official_last_name": "COOLEY STALEY",
        "authorized_official_first_name": "TINA",
        "authorized_official_title_or_position": "OWNER/OPTOMETRIST",
        "authorized_official_telephone_number": "480-813-7050",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "AZ",
            "license": "882",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Val Vista Vision Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Val Vista Vision Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gilbert, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2021; 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.