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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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