Provider Demographics
NPI:1871788133
Name:ANCALA EYE CARE P C
Entity type:Organization
Organization Name:ANCALA EYE CARE P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:L
Authorized Official - Last Name:GREENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:480-451-4519
Mailing Address - Street 1:11219 E VIA LINDA
Mailing Address - Street 2:SUITE D3
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-4069
Mailing Address - Country:US
Mailing Address - Phone:480-451-4519
Mailing Address - Fax:480-451-4858
Practice Address - Street 1:11219 E VIA LINDA
Practice Address - Street 2:SUITE D3
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85259-4069
Practice Address - Country:US
Practice Address - Phone:480-451-4519
Practice Address - Fax:480-451-4858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOD890152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZOD890OtherMEDICARE
AZ41176Medicare UPIN