Provider Demographics
NPI:1457247553
Name:AZ LIONS VISION AND HEARING FOUNDATION OF MD21
Entity type:Organization
Organization Name:AZ LIONS VISION AND HEARING FOUNDATION OF MD21
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-617-8051
Mailing Address - Street 1:2720 E THOMAS RD # A190
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-8299
Mailing Address - Country:US
Mailing Address - Phone:602-617-8051
Mailing Address - Fax:602-267-7595
Practice Address - Street 1:2720 E THOMAS RD # A190
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-8299
Practice Address - Country:US
Practice Address - Phone:602-617-8051
Practice Address - Fax:602-267-7595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health