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Organization subpart
No

Provider details

NPI number
Authorized official
MS. SUSAN A JOHNS (OFFICE MANAGER)
(602) 993-6400
Entity
Organization

Contact information

Practice address
9127 W THUNDERBIRD RD, #104, PEORIA, AZ 85381-4887
(602) 993-6400
(602) 866-2850
Mailing address
9127 W THUNDERBIRD RD, #104, PEORIA, AZ 85381-4887
(602) 993-6400
(602) 866-2850

Taxonomy

Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
20155482H
AZ

Other

Enumeration date
08/20/2007
Last updated
01/13/2010
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