Provider Demographics
NPI:1124579404
Name:DR GAUDREAU OPTOMETRY CORPORATION
Entity Type:Organization
Organization Name:DR GAUDREAU OPTOMETRY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PARYA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAUDREAU
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:408-399-8003
Mailing Address - Street 1:53 N SANTA CRUZ AVE
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95030-5916
Mailing Address - Country:US
Mailing Address - Phone:408-399-8003
Mailing Address - Fax:408-399-8004
Practice Address - Street 1:53 N SANTA CRUZ AVE
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95030-5916
Practice Address - Country:US
Practice Address - Phone:408-399-8003
Practice Address - Fax:408-399-8004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14533TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty