Provider Demographics
NPI:1073502167
Name:GARY L MORGAN OD PC
Entity Type:Organization
Organization Name:GARY L MORGAN OD PC
Other - Org Name:EYE TECH EYE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:GLASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-933-6586
Mailing Address - Street 1:18431 N 91ST AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-0817
Mailing Address - Country:US
Mailing Address - Phone:623-933-6586
Mailing Address - Fax:623-933-9320
Practice Address - Street 1:18431 N 91ST AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-0817
Practice Address - Country:US
Practice Address - Phone:623-933-6586
Practice Address - Fax:623-933-9320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-20
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ845152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZDD6558OtherRAILROAD MEDICARE
AZDD6558OtherRAILROAD MEDICARE
AZZ61715Medicare PIN