Organization
PBW OPTOMETRY PC
Active
Other names
Riverview Vision Center
Organization subpart
No
Provider details
NPI number
Authorized official
DOONE BURGENER (BUSINESS MANAGER)
(928) 505-5843
Entity
Organization
Contact information
Practice address
1923 MCCULLOCH BLVD #102, LAKE HAVASU CITY, AZ 86403-6722
(928) 854-3555
(928) 854-4544
Mailing address
1923 MCCULLOCH BLVD #102, LAKE HAVASU CITY, AZ 86403-6722
(928) 854-3555
(928) 854-4544
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
1060
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7547290001
MEDICARE NSC
—
Enumeration date
08/24/2016
Last updated
08/09/2017
Update your record
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