Provider Demographics
NPI:1053592428
Name:ASSOCIATED RETINA CONSULTANTS, LTD.
Entity type:Organization
Organization Name:ASSOCIATED RETINA CONSULTANTS, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALIST
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:K
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-216-1144
Mailing Address - Street 1:7600 N 15TH ST
Mailing Address - Street 2:SUITE 155
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-4327
Mailing Address - Country:US
Mailing Address - Phone:602-242-4928
Mailing Address - Fax:602-249-4813
Practice Address - Street 1:1022 WILLOW CREEK RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1607
Practice Address - Country:US
Practice Address - Phone:602-242-4928
Practice Address - Fax:602-249-4813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZWDBVFMedicare PIN