Shane Theobald OD

NPI 1760415947 - Optometrist - 152W00000X

NPI Details
NPI 1760415947
Gender Male
Enumeration Date 07/09/2006
Last Updated 03/04/2014
Entity Type Individual
Active Over 10 years ago
Practice Location
1717 W. CHANDLER BLVD
CHANDLER AZ, 85224, US
Phone (480) 821-7565
Fax (480) 821-4303
Business Location
25500 N. NORTERRA PARKWAY, BLDG B
PHOENIX AZ, 85085, US
Phone (623) 277-1000
Fax (602) 906-2789
Toxanomy
Taxonomy Code 152W00000X
License State Arizona
License Number 1521
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According to our database, Shane Theobald OD NPI is 1760415947, taxonomy code is 152W00000X and license number is 1521, license state is located at Arizona. Shane Theobald OD physically located at 1717 W. Chandler Blvd, Chandler AZ, 85224. NPI Number Shane Theobald OD has the Individual type.

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1760415947 NPI number is provided on an as is basis without warranty of any kind. 1760415947 is maintained by the National Plan & Provider Enumeration System. The contents of Shane Theobald OD are for informational purposes only.