Organization
EYE BOUTIQUE OF SEDONA, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROLYN JEANNE MARTIN CHANG OD (SOLE MEMBER)
(928) 301-0457
Entity
Organization
Contact information
Practice address
100 VERDE VALLEY SCHOOL RD, SUITE 114, SEDONA, AZ 86351-9053
(928) 239-9901
(928) 239-9902
Mailing address
80 HIGH VIEW DR, SEDONA, AZ 86351-6961
(928) 301-0457
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1467
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1255304754
INDIVIDUAL NPI
—
05
—
612863
—
AZ
Enumeration date
11/22/2013
Last updated
11/22/2013
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