Provider Demographics
NPI:1043079783
Name:ENVISION EYECARE LLC
Entity type:Organization
Organization Name:ENVISION EYECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER / SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:YAMILE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMAGUERA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:602-494-7336
Mailing Address - Street 1:12605 N TATUM BLVD # A111
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-7710
Mailing Address - Country:US
Mailing Address - Phone:602-494-7336
Mailing Address - Fax:
Practice Address - Street 1:12605 N TATUM BLVD # A111
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-7710
Practice Address - Country:US
Practice Address - Phone:602-494-7333
Practice Address - Fax:480-701-8050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management