Provider Demographics
NPI:1073536215
Name:DAVID J GAJDA, MD, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DAVID J GAJDA, MD, A PROFESSIONAL CORPORATION
Other - Org Name:EYE LIFE INSTITUE ASC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:GAJDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-877-2020
Mailing Address - Street 1:6283 CLARK RD
Mailing Address - Street 2:#10
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-4100
Mailing Address - Country:US
Mailing Address - Phone:530-877-2020
Mailing Address - Fax:530-877-4641
Practice Address - Street 1:6283 CLARK RD
Practice Address - Street 2:#11
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-4100
Practice Address - Country:US
Practice Address - Phone:530-877-2020
Practice Address - Fax:530-877-4641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ51128ZOtherBLUE CROSS
CAZZZ51128ZOtherBLUE SHIELD
CAZZZ51128ZMedicare ID - Type Unspecified