Organization
BELLA VISTA OPTICAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SELVIN GNANAKKAN O.D. (MEDICAL DIRECTOR)
(602) 770-9300
Entity
Organization
Contact information
Practice address
7122 N 59TH AVE FL 1, GLENDALE, AZ 85301-2436
(623) 931-1043
Mailing address
7734 N 59TH AVE, SUITE 102, GLENDALE, AZ 85301-7816
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
261QH0100X
Health Service Clinic/Center
—
—
Other
Enumeration date
10/25/2011
Last updated
04/14/2021
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