NPIMap

Organization Active NPI

PBW Optometry PC

Doing business as Riverview Vision Center

  • Eyewear Supplier
  • Lake Havasu City, AZ
National Provider Identifier
1871048405
Registry record updated Aug 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
License
1060 Issued in AZ
Legal business name
PBW OPTOMETRY PC
Doing business as
Riverview Vision Center
Practice address
1923 McCulloch Blvd #102
Lake Havasu City, AZ 86403-6722
Phone
(928) 854-3555
Fax
(928) 854-4544
NPI assigned
Aug 24, 2016
Last updated
Aug 9, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2017

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

Authorized official

Name
Doone Burgener
Title
Business Manager
Phone
(928) 505-5843

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X 1060 AZ Primary

Addresses

Primary practice location

1923 McCulloch Blvd #102
Lake Havasu City, AZ 86403-6722

Mailing address

1923 McCulloch Blvd #102
Lake Havasu City, AZ 86403-6722
Phone (928) 854-3555

Other identifiers 1

IdentifierTypeStateIssuer
7547290001OtherMEDICARE NSC

Other names 1

  • Riverview Vision Center Doing business as

National Provider Directory

National Provider Directory

Locations

3640 Highway 95
Ste 100
Bullhead City, AZ 86442
Phone (928) 224-5557

14 Scott Dr
Lk Havasu Cty, AZ 86403
Phone (928) 854-3555

Practitioners & affiliated clinicians

Practitioners 5

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": "1471996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1502236800000",
    "number": "1871048405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1923 MCCULLOCH BLVD #102",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864036722",
            "telephone_number": "928-854-3555",
            "fax_number": "928-854-4544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1923 MCCULLOCH BLVD #102",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864036722",
            "telephone_number": "928-854-3555",
            "fax_number": "928-854-4544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PBW OPTOMETRY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-24",
        "last_updated": "2017-08-09",
        "status": "A",
        "authorized_official_last_name": "BURGENER",
        "authorized_official_first_name": "DOONE",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "928-505-5843"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "AZ",
            "license": "1060",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE NSC",
            "identifier": "7547290001",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Riverview Vision Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Havasu City, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2017; 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.