Provider Demographics
NPI:1184651390
Name:ENGLUND, GARY LOWELL (OD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:LOWELL
Last Name:ENGLUND
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:PO BOX 6040
Mailing Address - Street 2:1112 VINE ST
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446
Mailing Address - Country:US
Mailing Address - Phone:805-528-5333
Mailing Address - Fax:805-528-7723
Practice Address - Street 1:2231 BAYVIEW HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:LOS OSOS
Practice Address - State:CA
Practice Address - Zip Code:93402-3900
Practice Address - Country:US
Practice Address - Phone:805-528-5333
Practice Address - Fax:805-528-7723
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6208T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0062080Medicaid
CAGSD001440Medicaid
CA0312300001Medicare NSC
CA0312300002Medicare NSC
CAWOP6208AMedicare PIN
CAWOP6208BMedicare PIN
CAGSD001440Medicaid