Provider Demographics
NPI:1215619283
Name:MARKETPLACE OPTICAL LLC
Entity type:Organization
Organization Name:MARKETPLACE OPTICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARJUN
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:480-980-3873
Mailing Address - Street 1:1495 E. TUCSON MARKETPLACE BLVD
Mailing Address - Street 2:STE 161
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85713-0047
Mailing Address - Country:US
Mailing Address - Phone:480-980-3873
Mailing Address - Fax:520-200-5769
Practice Address - Street 1:1495 E TUCSON MARKETPLACE BLVD STE 161
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85713-0047
Practice Address - Country:US
Practice Address - Phone:520-221-4373
Practice Address - Fax:520-200-5769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-01
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty