Organization
SAN TAN EYECARE PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACK L HOSTETLER OD (MEMBER)
(480) 807-0288
Entity
Organization
Contact information
Practice address
2680 S VAL VISTA DR, SUITE 111, GILBERT, AZ 85295-1606
(480) 807-0288
(480) 290-7199
Mailing address
2680 S VAL VISTA DR, SUITE 111, GILBERT, AZ 85295-1606
(480) 807-0288
(480) 290-7199
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1307
AZ
152W00000X
Optometrist
349
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0917440001
DMERC
AZ
Enumeration date
12/27/2007
Last updated
03/07/2012
Update your record
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