Individual
JOHN MORTENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
204 W MARIPOSA RD, SUITE 24, NOGALES, AZ 85621-1007
(520) 287-3233
(520) 281-4583
Mailing address
220 N MCKEMY AVE, CHANDLER, AZ 85226-2654
(480) 961-1865
(480) 893-8172
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2118
AZ
Other
Enumeration date
07/07/2016
Last updated
07/07/2016
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