Individual
INGA LILLIANA FORS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
15725 S 46TH ST STE 112, PHOENIX, AZ 85048-0443
(480) 893-2300
Mailing address
15725 S 46TH ST STE 112, PHOENIX, AZ 85048-0443
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2180
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2180
AZ STATE BOARD OF OPTOMETRY LICENSE
AZ
Enumeration date
08/09/2017
Last updated
08/09/2017
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