| Active Eyecare Of Surprise | |
|
16968 W Bell Rd Suite 402 Surprise AZ 85374-8943 | |
| (623) 214-0353 | |
| (623) 214-0693 |
| Full Name | Active Eyecare Of Surprise |
|---|---|
| Speciality | Clinic/Center |
| Location | 16968 W Bell Rd, Surprise, Arizona |
| Authorized Official Name and Position | Mark Edward Fechtel (OWNER) |
| Authorized Official Contact | 6232140353 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Active Eyecare Of Surprise 16968 W Bell Rd Suite 402 Surprise AZ 85374-8943 Ph: (623) 214-0353 | Active Eyecare Of Surprise 16968 W Bell Rd Suite 402 Surprise AZ 85374-8943 Ph: (623) 214-0353 |
| NPI Number | 1295100204 |
|---|---|
| Provider Enumeration Date | 12/02/2015 |
| Last Update Date | 12/02/2015 |
| Medicare PECOS PAC ID | 8426316993 |
|---|---|
| Medicare Enrollment ID | O20171212000108 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295100204 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 1117 (Arizona) | Primary |
| Provider Name | Mark E Fechtel |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1356338636 PECOS PAC ID: 3971601691 Enrollment ID: I20070604000678 |
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