Provider Demographics
NPI:1215247184
Name:HISCOX OPTOMETRY P.L.L.C.
Entity type:Organization
Organization Name:HISCOX OPTOMETRY P.L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:WYLEY
Authorized Official - Last Name:HISCOX
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:520-885-2052
Mailing Address - Street 1:7402 E BROADWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-1411
Mailing Address - Country:US
Mailing Address - Phone:520-885-2052
Mailing Address - Fax:520-886-7488
Practice Address - Street 1:7402 E BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-1411
Practice Address - Country:US
Practice Address - Phone:520-885-2052
Practice Address - Fax:520-886-7488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-13
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1643152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty