Provider Demographics
NPI:1467784389
Name:GREGORY, ANTHONY II
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:
Last Name:GREGORY
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2619 E COLORADO BLVD # 150
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-3747
Mailing Address - Country:US
Mailing Address - Phone:678-643-8633
Mailing Address - Fax:
Practice Address - Street 1:399 E HIGHLAND AVE STE 401
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-3862
Practice Address - Country:US
Practice Address - Phone:909-327-3118
Practice Address - Fax:909-327-3119
Is Sole Proprietor?:No
Enumeration Date:2010-02-02
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA073956207W00000X
CAA140370207WX0009X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology