Provider Demographics
NPI:1881721520
Name:ULMER, GARY LOUIS (LICENSED OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:LOUIS
Last Name:ULMER
Suffix:
Gender:M
Credentials:LICENSED OPTICIAN
Other - Prefix:MRS
Other - First Name:MAUREEN
Other - Middle Name:PATRICIA
Other - Last Name:ULMER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OPTICIAN
Mailing Address - Street 1:1450 W SOUTHERN AVE
Mailing Address - Street 2:SUITE #8
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-4860
Mailing Address - Country:US
Mailing Address - Phone:480-835-9669
Mailing Address - Fax:480-835-7962
Practice Address - Street 1:1450 W SOUTHERN AVE
Practice Address - Street 2:SUITE #8
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4860
Practice Address - Country:US
Practice Address - Phone:480-835-9669
Practice Address - Fax:480-835-7962
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ358156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician