Nancy De la Vara
Individual provider Active NPI Optician · Somerton, AZ
NPI 1790089928 · NPPES record last updated Aug 14, 2013
Key facts
- NPI
- 1790089928
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optician 156FX1800X
- License
- 2571I (AZ)
- Practice address
- 725 E. Main St.
Suite 1C
Somerton, AZ 85350-0634 - Phone
- (928) 627-4525
- NPI assigned
- Jan 3, 2011
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2571I | AZ | MD | Optician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Somerton Eyecare Center Inc | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optician | 156FX1800X | 2571I | AZ | Yes |
Addresses
Primary practice location
725 E. Main St.
Suite 1C
Somerton, AZ 85350-0634
Mailing address
PO Box 634
Somerton, AZ 85350-0634
Phone (928) 627-4525
Other providers in Somerton, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 14, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.