Organization
ROADRUNNER OPTICAL CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. HEIDI BAKER (MANAGER)
(928) 445-3808
Entity
Organization
Contact information
Practice address
377 N MONTEZUMA ST, STE 108A, PRESCOTT, AZ 86301-3020
(928) 445-3808
(928) 778-3559
Mailing address
377 N MONTEZUMA ST, STE 108A, PRESCOTT, AZ 86301-3020
(928) 445-3808
(928) 778-3559
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
13-046129-A
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110664
EYEMED
AZ
01
—
14720
SPECTERA
AZ
01
—
3813
AVESIS
AZ
01
—
43017
DAVIS VISION
AZ
01
—
AZ0904090
BLUE CROSS BLUE SHEILD OF
AZ
Enumeration date
10/18/2006
Last updated
06/27/2014
Update your record
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