Provider Demographics
NPI:1033253067
Name:LOUIE, GARY M (OD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:M
Last Name:LOUIE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34724 ALVARADO NILES RD
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-4502
Mailing Address - Country:US
Mailing Address - Phone:510-489-5510
Mailing Address - Fax:510-489-5658
Practice Address - Street 1:34724 ALVARADO NILES RD
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-4502
Practice Address - Country:US
Practice Address - Phone:510-489-5510
Practice Address - Fax:510-489-5658
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6732T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0067320Medicaid
CAT10400Medicare UPIN
CA0810840001Medicare NSC