Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 1338 | AZ |
NPI | 1003901828 |
---|---|
Provider Name | Marci Pieper |
First Address | Mesa, AZ 85206-4673 |
Second Address | Gilbert, AZ 85234 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 02/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
866080 | (05) | AZ |
AZ0904550 | BCBS (01) | AZ |
U66482 | (02) | AZ |