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Individual

DR. KHRYS GATES

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
OD

Contact information

Practice address
HWY 264 MILE POST 388, POLACCA, AZ 86042-4000
(928) 737-6003
(928) 737-6080
Mailing address
PO BOX 4000, POLACCA, AZ 86042-4000
(928) 737-6003
(928) 737-6080

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2845
CO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
020529
AZ
Enumeration date
09/27/2011
Last updated
05/09/2012
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