Provider Demographics
NPI:1760485874
Name:MORGAN, GARY L (OD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:L
Last Name:MORGAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
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:928-583-7992
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:928-583-7992
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ845152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ129967Medicaid
AZ410022566OtherRAILROAD MEDICARE PIN
AZZ61716Medicare PIN