Provider Demographics
NPI:1114964939
Name:SEDONA EYE CARE PC
Entity type:Organization
Organization Name:SEDONA EYE CARE PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SERGE
Authorized Official - Middle Name:W
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:928-282-4126
Mailing Address - Street 1:95 SOLDIERS PASS ROAD
Mailing Address - Street 2:STE A1
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-4781
Mailing Address - Country:US
Mailing Address - Phone:928-282-4126
Mailing Address - Fax:928-282-5762
Practice Address - Street 1:95 SOLDIERS PASS ROAD
Practice Address - Street 2:STE A1
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-4781
Practice Address - Country:US
Practice Address - Phone:928-282-4126
Practice Address - Fax:928-282-5762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ262152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0171820OtherBLUE CROSS BLUE SHIELD
T76958Medicare UPIN
ZWCKNPMedicare ID - Type Unspecified
0741150002Medicare NSC