Individual
DEREK JEANES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3192 WILLOW CREEK RD, PRESCOTT, AZ 86301-6610
(928) 445-1234
(602) 508-4830
Mailing address
63 S ROCKFORD DR STE 220, TEMPE, AZ 85288-6226
(928) 445-1324
(602) 508-4830
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT-002719
AZ
Other
Enumeration date
05/03/2023
Last updated
07/19/2023
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