MEDICARE: DR. GARY L MORGAN 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
1	152W00000X	Optometrist	AZ845	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	410022566	OTHER	AZ	RAILROAD MEDICARE PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760485874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY L MORGAN O.D.

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	:	928-583-7992

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	:	928-583-7992

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	11/10/2021

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