Provider Demographics
NPI:1902051253
Name:GATEWAY OPTOMETRY PLC
Entity Type:Organization
Organization Name:GATEWAY OPTOMETRY PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SVETLANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALESHINA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:617-875-7074
Mailing Address - Street 1:1002 E OSBORN RD UNIT A
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-5222
Mailing Address - Country:US
Mailing Address - Phone:617-875-7074
Mailing Address - Fax:
Practice Address - Street 1:4435 W ANTHEM WAY
Practice Address - Street 2:WAL MART VISION CENTER
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-0467
Practice Address - Country:US
Practice Address - Phone:617-875-7074
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-28
Last Update Date:2008-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty