Provider Demographics
NPI:1851572069
Name:GRAYHAWK EYE CENTER
Entity Type:Organization
Organization Name:GRAYHAWK EYE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-419-3937
Mailing Address - Street 1:20201 N SCOTTSDALE HEALTHCARE DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-4134
Mailing Address - Country:US
Mailing Address - Phone:480-419-3937
Mailing Address - Fax:
Practice Address - Street 1:20201 N SCOTTSDALE HEALTHCARE DR
Practice Address - Street 2:SUITE 220
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-4134
Practice Address - Country:US
Practice Address - Phone:480-419-3937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ3545305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ69820Medicare PIN