Organization
SPECTRA EYE INSTITUTE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAN AMATOR (CEO)
(623) 583-2020
Entity
Organization
Contact information
Practice address
15401 N 29TH AVE, 201, PHOENIX, AZ 85053-4001
(623) 583-2020
(623) 583-2513
Mailing address
15401 N 29TH AVE STE 201, PHOENIX, AZ 85053-4000
(623) 583-2020
(623) 583-2075
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
—
—
261QS0132X
Ophthalmologic Surgery Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
544256
AHCCCS
AZ
Enumeration date
03/20/2017
Last updated
11/15/2021
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