Organization
OCOTILLO EYECARE P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY CRAIG POWELL (PRESIDENT)
(480) 812-3937
Entity
Organization
Contact information
Practice address
3940 S ALMA SCHOOL RD, SUITE 5, CHANDLER, AZ 85248-4513
(480) 812-3937
Mailing address
1674 W YELLOWSTONE WAY, CHANDLER, AZ 85248-4867
(480) 786-6837
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0748
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
120468
MEDICARE PART B
AZ
Enumeration date
06/26/2007
Last updated
04/24/2008
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