Individual
JAMES LICATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LDO
Contact information
Practice address
2048 E BASELINE RD # C-6, MESA, AZ 85204-6969
(480) 632-5075
(480) 507-0836
Mailing address
2048 E BASELINE RD # C-6, MESA, AZ 85204-6969
(480) 632-5075
(480) 507-0836
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
748
AZ
Other
Enumeration date
06/08/2011
Last updated
06/08/2011
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