Provider Demographics
NPI:1285809913
Name:SONORAN DESERT EYE CENTER, LLC
Entity type:Organization
Organization Name:SONORAN DESERT EYE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:QUARANTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-812-2211
Mailing Address - Street 1:2211 E PECOS RD
Mailing Address - Street 2:1
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-6142
Mailing Address - Country:US
Mailing Address - Phone:480-812-2211
Mailing Address - Fax:
Practice Address - Street 1:2211 E PECOS RD
Practice Address - Street 2:1
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-6142
Practice Address - Country:US
Practice Address - Phone:480-812-2211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ945152W00000X
332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0945OtherSTATE OF ARIZONA