Provider Demographics
NPI:1497390173
Name:GAMMARANO, KEYLA A (OD)
Entity Type:Individual
Prefix:
First Name:KEYLA
Middle Name:A
Last Name:GAMMARANO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2875 W RAY RD
Mailing Address - Street 2:SUITE 6 #148
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224
Mailing Address - Country:US
Mailing Address - Phone:480-567-9862
Mailing Address - Fax:
Practice Address - Street 1:4734 E RAY RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-6225
Practice Address - Country:US
Practice Address - Phone:480-567-9862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-17
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2410152W00000X
TX9878T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist