Provider Demographics
NPI:1962938498
Name:EXPERT AZ EYECARE LLC
Entity type:Organization
Organization Name:EXPERT AZ EYECARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:FILATOVA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:480-985-0086
Mailing Address - Street 1:1423 S HIGLEY RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-3429
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1423 S HIGLEY RD
Practice Address - Street 2:SUITE 104
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-3429
Practice Address - Country:US
Practice Address - Phone:480-985-0086
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-03
Last Update Date:2017-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1936261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service