Provider Demographics
NPI:1326672221
Name:TRITON CARE SYSTEMS PLLC
Entity Type:Organization
Organization Name:TRITON CARE SYSTEMS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:623-640-5390
Mailing Address - Street 1:3155 STILLWATER DR STE A
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-7172
Mailing Address - Country:US
Mailing Address - Phone:928-227-1738
Mailing Address - Fax:
Practice Address - Street 1:3155 STILLWATER DR STE A
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-7172
Practice Address - Country:US
Practice Address - Phone:928-227-1738
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-28
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1760485874OtherNPI TYPE 1