1881721520 NPI number — MR. GARY LOUIS ULMER LICENSED OPTICIAN

Table of content: MR. GARY LOUIS ULMER LICENSED OPTICIAN (NPI 1881721520)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881721520 NPI number — MR. GARY LOUIS ULMER LICENSED OPTICIAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ULMER
Provider First Name:
GARY
Provider Middle Name:
LOUIS
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LICENSED OPTICIAN
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ULMER
Provider Other First Name:
MAUREEN
Provider Other Middle Name:
PATRICIA
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
OPTICIAN
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1881721520
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1450 W SOUTHERN AVE
Provider Second Line Business Mailing Address:
SUITE #8
Provider Business Mailing Address City Name:
MESA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85202-4860
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-835-9669
Provider Business Mailing Address Fax Number:
480-835-7962

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1450 W SOUTHERN AVE
Provider Second Line Business Practice Location Address:
SUITE #8
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85202-4860
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-835-9669
Provider Business Practice Location Address Fax Number:
480-835-7962
Provider Enumeration Date:
02/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 156FX1800X , with the licence number:  358 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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