Provider Demographics
NPI:1982415717
Name:MONTEMAYOR, JOEL MARK (ABO,NCLE,LDO)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:MARK
Last Name:MONTEMAYOR
Suffix:
Gender:
Credentials:ABO,NCLE,LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33559 N NORTH BUTTE DR
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85144-6388
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1725 W HUNT HWY
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85143-5203
Practice Address - Country:US
Practice Address - Phone:480-358-4346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-20
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2369I156FX1800X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician