MEDICARE: TRITON CARE SYSTEMS PLLC

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
1	152W00000X	Optometrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1760485874	OTHER		NPI TYPE 1

General Provider Information

NPI Number	:	1326672221
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRITON CARE SYSTEMS PLLC

Provider Business Mailing Address
First Line	:	3155 STILLWATER DR STE A
Second Line	:
City	:	PRESCOTT
State	:	AZ
Zip	:	86305-7172
Country	:	US
Telephone Number	:	928-227-1738
Fax Number	:

Provider Business Practice Location Address
First Line	:	3155 STILLWATER DR STE A
Second Line	:
City	:	PRESCOTT
State	:	AZ
Zip	:	86305-7172
Country	:	US
Telephone Number	:	928-227-1738
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	GARY LEE MORGAN
Credential	:	OD
Telephone Number	:	623-640-5390

Provider Enumeration Date	:	02/28/2020
Last Update Date	:	02/28/2020

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Directions to “TRITON CARE SYSTEMS PLLC ” Practice Location

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