Eye Boutique of Sedona, PLLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

1467 Issued in AZ

Legal business name

EYE BOUTIQUE OF SEDONA, PLLC

Practice address

100 Verde Valley School Rd
Suite 114
Sedona, AZ 86351-9053

Phone

(928) 239-9901

Fax

(928) 239-9902

NPI assigned

Nov 22, 2013

Organization subpart

No

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

Authorized official

Name

Carolyn Jeanne Martin Chang, OD

Title

Sole Member

Phone

(928) 301-0457

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Locations

Practitioners 1

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

• Carolyn J Martin, O.D.

  • Optometrist
  • Sedona, AZ
  • NPI 1255304754
  Medicare reassignment NPD

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

{
    "created_epoch": "1385078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1385078400000",
    "number": "1669802013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80 HIGH VIEW DR",
            "city": "SEDONA",
            "state": "AZ",
            "postal_code": "863516961",
            "telephone_number": "928-301-0457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 VERDE VALLEY SCHOOL RD",
            "address_2": "SUITE 114",
            "city": "SEDONA",
            "state": "AZ",
            "postal_code": "863519053",
            "telephone_number": "928-239-9901",
            "fax_number": "928-239-9902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE BOUTIQUE OF SEDONA, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-22",
        "last_updated": "2013-11-22",
        "status": "A",
        "authorized_official_last_name": "CHANG",
        "authorized_official_first_name": "CAROLYN",
        "authorized_official_middle_name": "JEANNE MARTIN",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "928-301-0457",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "AZ",
            "license": "1467",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "612863",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1255304754",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Sedona, AZ
• Providers in Sedona, AZ by specialty
• Optometrist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2013; 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.