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NPI Code Detail

MEDICARE: GARY GENE GRAMMOND O.D.

MEDICARE: GARY GENE GRAMMOND O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist81AZ

General Provider Information

NPI Number : 1144216409
Entity Type Code : Individual
Provider Name (Legal Business Name) : GARY GENE GRAMMOND O.D.
Provider Business Mailing Address
First Line : 6412 E SHEPHERD HLS
Second Line :
City : TUCSON
State : AZ
Zip : 85710-1125
Country : US
Telephone Number : 520-751-1024
Fax Number : 520-751-4392
Provider Business Practice Location Address
First Line : 7150 E SPEEDWAY BLVD
Second Line :
City : TUCSON
State : AZ
Zip : 85710-1318
Country : US
Telephone Number : 520-751-1024
Fax Number : 520-751-4392
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2005
Last Update Date : 07/08/2007

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