Licata Optical LLC – Eyewear Supplier in Mesa, AZ

Key facts

NPI: 1851675003
Entity type: Organization (NPI type 2)
Primary specialty: Eyewear Supplier 332H00000X
License: 1185E (AZ)
Legal business name: LICATA OPTICAL LLC
Practice address: 2048 E Baseline Rd
C-6
Mesa, AZ 85204-6969
Phone: (480) 632-5075
Fax: (480) 507-0836
NPI assigned: Oct 6, 2011
Organization subpart: No

Authorized official

Name: Mr. James J Licata, LDO NPI 1295029072
Title: Manager/Optician
Phone: (480) 632-5075

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

Practitioners 1

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

James Licata, LDO Optician · Mesa, AZ · NPI 1295029072

NPD (past) Authorized official

National Provider Directory

Locations

2048 E Baseline Rd
#C6
Mesa, AZ 85204
Phone (480) 632-5075

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Eyewear Supplier	332H00000X	1185E	AZ	Yes

Addresses

Primary practice location

2048 E Baseline Rd
C-6
Mesa, AZ 85204-6969

Mailing address

2048 E Baseline Rd
C-6
Mesa, AZ 85204-6969
Phone (480) 632-5075

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 6, 2011.

{
    "created_epoch": "1317859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317859200000",
    "number": "1851675003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2048 E BASELINE RD",
            "address_2": "C-6",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852046969",
            "telephone_number": "480-632-5075",
            "fax_number": "480-507-0836"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2048 E BASELINE RD",
            "address_2": "C-6",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852046969",
            "telephone_number": "480-632-5075",
            "fax_number": "480-507-0836"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LICATA OPTICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-06",
        "last_updated": "2011-10-06",
        "status": "A",
        "authorized_official_last_name": "LICATA",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "MANAGER/OPTICIAN",
        "authorized_official_telephone_number": "480-632-5075",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LDO"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "AZ",
            "license": "1185E",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

All providers in Mesa, AZ · Eyewear Supplier in Arizona

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 6, 2011. 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.

Verify at the official NPI Registry.