Provider Demographics
NPI:1487837654
Name:AZ EYE HEALTH PLLC
Entity Type:Organization
Organization Name:AZ EYE HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:K
Authorized Official - Last Name:GRAMLICH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:480-585-0001
Mailing Address - Street 1:8575 E PRINCESS DR
Mailing Address - Street 2:#105
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-5483
Mailing Address - Country:US
Mailing Address - Phone:480-585-0001
Mailing Address - Fax:480-585-0760
Practice Address - Street 1:8575 E PRINCESS DR
Practice Address - Street 2:#105
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-5483
Practice Address - Country:US
Practice Address - Phone:480-585-0001
Practice Address - Fax:480-585-0760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1105152W00000X
AZ1049152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ70768Medicaid
AZ63361Medicaid
AZU82366Medicare UPIN
AZZ79143Medicare PIN
AZ63361Medicaid