Provider Demographics
NPI:1386892602
Name:OPTOMETRIC SPECIAL TESTING CENTERS, INC.
Entity type:Organization
Organization Name:OPTOMETRIC SPECIAL TESTING CENTERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:480-755-1925
Mailing Address - Street 1:13610 N SCOTTSDALE RD
Mailing Address - Street 2:SUITE13
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-4037
Mailing Address - Country:US
Mailing Address - Phone:480-755-1925
Mailing Address - Fax:480-755-3907
Practice Address - Street 1:13610 N SCOTTSDALE RD
Practice Address - Street 2:SUITE13
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-4037
Practice Address - Country:US
Practice Address - Phone:480-755-1925
Practice Address - Fax:480-755-3907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ37152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ80556Medicare PIN