Provider Demographics
NPI:1275752214
Name:GATESH OPTICIANS
Entity Type:Organization
Organization Name:GATESH OPTICIANS
Other - Org Name:GATESH OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:GATESH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-947-2171
Mailing Address - Street 1:7113 E 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-4305
Mailing Address - Country:US
Mailing Address - Phone:480-947-2171
Mailing Address - Fax:480-990-1012
Practice Address - Street 1:7113 E 1ST AVE
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-4305
Practice Address - Country:US
Practice Address - Phone:480-947-2171
Practice Address - Fax:480-990-1012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ07081073U156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0743070001Medicare NSC