Provider Demographics
NPI:1124064654
Name:SAN TAN EYECARE - PARADISE VALLEY, PLLC
Entity type:Organization
Organization Name:SAN TAN EYECARE - PARADISE VALLEY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:N
Authorized Official - Last Name:CHRISAGIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:480-967-4910
Mailing Address - Street 1:4550 E BELL RD STE 104
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-9342
Mailing Address - Country:US
Mailing Address - Phone:602-661-6519
Mailing Address - Fax:602-996-4231
Practice Address - Street 1:4550 E BELL RD STE 104
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-9342
Practice Address - Country:US
Practice Address - Phone:602-661-6519
Practice Address - Fax:602-996-4231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty