Provider Demographics
NPI:1144216409
Name:GRAMMOND, GARY GENE (OD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:GENE
Last Name:GRAMMOND
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6412 E SHEPHERD HLS
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-1125
Mailing Address - Country:US
Mailing Address - Phone:520-751-1024
Mailing Address - Fax:520-751-4392
Practice Address - Street 1:7150 E SPEEDWAY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-1318
Practice Address - Country:US
Practice Address - Phone:520-751-1024
Practice Address - Fax:520-751-4392
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ81152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist