Provider Demographics
NPI:1376894758
Name:MEDICAL EYE ASSOCIATES OF PHOENIX PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MEDICAL EYE ASSOCIATES OF PHOENIX PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-948-3038
Mailing Address - Street 1:7840 MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-4301
Mailing Address - Country:US
Mailing Address - Phone:513-354-5808
Mailing Address - Fax:513-354-5774
Practice Address - Street 1:16427 N SCOTTSDALE RD
Practice Address - Street 2:SUITE 105
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-8197
Practice Address - Country:US
Practice Address - Phone:480-948-3038
Practice Address - Fax:480-366-3942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3545207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty