Provider Demographics
NPI:1306806732
Name:EYTAN, OFER N (MD)
Entity type:Individual
Prefix:DR
First Name:OFER
Middle Name:N
Last Name:EYTAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2525 W GREENWAY RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-4226
Mailing Address - Country:US
Mailing Address - Phone:602-993-6400
Mailing Address - Fax:602-866-2850
Practice Address - Street 1:2525 W GREENWAY RD
Practice Address - Street 2:SUITE 120
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85023-4226
Practice Address - Country:US
Practice Address - Phone:602-993-6400
Practice Address - Fax:602-866-2850
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ21915207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ173112Medicaid
AZF71894Medicare UPIN
AZWDBVS02Medicare ID - Type Unspecified