Provider Demographics
NPI:1063998763
Name:VISION INDEPENDENCE SERVICES OF ARIZONA, LLC
Entity type:Organization
Organization Name:VISION INDEPENDENCE SERVICES OF ARIZONA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:OTD
Authorized Official - Phone:480-294-3080
Mailing Address - Street 1:3031 W COTTONWOOD LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85045-2232
Mailing Address - Country:US
Mailing Address - Phone:480-294-3080
Mailing Address - Fax:
Practice Address - Street 1:3031 W COTTONWOOD LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85045-2232
Practice Address - Country:US
Practice Address - Phone:480-294-3080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-16
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4548225XL0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XL0004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistLow VisionGroup - Single Specialty