Provider Demographics
NPI:1144211590
Name:GRAMLICH, BRETT (OD)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:
Last Name:GRAMLICH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8575 E PRINCESS DR
Mailing Address - Street 2:#105
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-5483
Mailing Address - Country:US
Mailing Address - Phone:480-585-0001
Mailing Address - Fax:480-585-0760
Practice Address - Street 1:8575 E PRINCESS DR
Practice Address - Street 2:#105
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-5483
Practice Address - Country:US
Practice Address - Phone:480-585-0001
Practice Address - Fax:480-585-0760
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1049152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ70768Medicare ID - Type UnspecifiedMEDICARE/MEDICAID NUMBER
AZU81460Medicare UPIN