Provider Demographics
NPI:1780777011
Name:TUCKMAN, GREG (OD)
Entity type:Individual
Prefix:DR
First Name:GREG
Middle Name:
Last Name:TUCKMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 E CONCORDA DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-3517
Mailing Address - Country:US
Mailing Address - Phone:480-968-2768
Mailing Address - Fax:
Practice Address - Street 1:9001 N 29TH AVE # E1/2
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-3464
Practice Address - Country:US
Practice Address - Phone:602-944-2444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ501152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist