Organization
NORTHERN ARIZONA EYE ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA GRIMES (ADMINISTRATOR)
(928) 779-7000
Entity
Organization
Contact information
Practice address
900 N SAN FRANCISCO ST, FLAGSTAFF, AZ 86001-3236
(928) 779-7000
Mailing address
900 N SAN FRANCISCO ST, FLAGSTAFF, AZ 86001-3236
(928) 779-7000
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
180022943
MEDICARE RR GROUP ID
—
05
—
290066
—
AZ
01
—
DG6643
MEDICARE RAILROAD GROUP ID
—
Enumeration date
11/17/2006
Last updated
04/25/2008
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