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NANCY DE LA VARA

Optician >> Technician/Technologist >> Eye and Vision Services Providers

Registrant NPI Number: 1790089928

Individual Registrant:
 NANCY  DE LA VARA 
Gender: F
Not Sole Proprietor

Location and contact information for practice:
725 E. MAIN ST. SUITE 1C SOMERTON, AZ 85350-0634 US
Tel: 928-627-4525  Fax: --

Contact information for business:
PO BOX 634  SOMERTON, AZ 85350-0634 US
Tel: 928-627-4525  Fax: --

Registration Information:
NPI: 1790089928
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y156FX1800XEye and Vision Services Providers
Technician/Technologist
Optician
AZ2571I

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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