Provider Demographics
NPI:1821175472
Name:NATIONAL EYE AND EAR OF TUCSON INC
Entity Type:Organization
Organization Name:NATIONAL EYE AND EAR OF TUCSON INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:GOSSES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:520-795-0553
Mailing Address - Street 1:4540 E GRANT RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2617
Mailing Address - Country:US
Mailing Address - Phone:520-795-0553
Mailing Address - Fax:
Practice Address - Street 1:4540 E GRANT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2617
Practice Address - Country:US
Practice Address - Phone:520-795-0553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ478152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZT41660Medicare UPIN