Provider Demographics
NPI:1215995949
Name:PLAZA DEL RIO EYE CLINIC, PC
Entity type:Organization
Organization Name:PLAZA DEL RIO EYE CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRYSANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:RINDERKNECHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-977-8341
Mailing Address - Street 1:13340 N 94TH DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4236
Mailing Address - Country:US
Mailing Address - Phone:623-977-8341
Mailing Address - Fax:623-933-2952
Practice Address - Street 1:13340 N 94TH DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4236
Practice Address - Country:US
Practice Address - Phone:623-977-8341
Practice Address - Fax:623-933-2952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22636207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZF87039Medicare UPIN