Provider Demographics
NPI:1255317780
Name:GAYLORD, ERIC E (OD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:E
Last Name:GAYLORD
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 1:3750 SANTA ROSALIA DR STE 102
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-3685
Mailing Address - Country:US
Mailing Address - Phone:323-294-7517
Mailing Address - Fax:
Practice Address - Street 1:3750 SANTA ROSALIA DR STE 102
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90008-3685
Practice Address - Country:US
Practice Address - Phone:323-294-7517
Practice Address - Fax:323-294-9219
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT8724T152W00000X
CA8724152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0087240Medicaid
CASD0087240Medicaid
CAWOP8724BMedicare PIN
CAWOP8724BMedicare PIN