Provider Demographics
NPI:1588665269
Name:RF EYE PC
Entity type:Organization
Organization Name:RF EYE PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LETISHA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:KUDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-458-8131
Mailing Address - Street 1:2445 E WILCOX DR
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635
Mailing Address - Country:US
Mailing Address - Phone:520-458-8131
Mailing Address - Fax:520-458-0422
Practice Address - Street 1:2445 E WILCOX DR
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635
Practice Address - Country:US
Practice Address - Phone:520-458-8131
Practice Address - Fax:520-458-0422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ118754001AZMedicaid
X22364Medicare UPIN
AZ118754001AZMedicaid