Provider Demographics
NPI:1275693251
Name:SCHEFFEL, GARY KEITH SR (OD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:KEITH
Last Name:SCHEFFEL
Suffix:SR
Gender:M
Credentials:OD
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Mailing Address - Street 1:9490 MADISON AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:ORANGEVALE
Mailing Address - State:CA
Mailing Address - Zip Code:95662-4983
Mailing Address - Country:US
Mailing Address - Phone:916-988-2212
Mailing Address - Fax:916-988-8578
Practice Address - Street 1:9490 MADISON AVE STE 100
Practice Address - Street 2:
Practice Address - City:ORANGEVALE
Practice Address - State:CA
Practice Address - Zip Code:95662-4983
Practice Address - Country:US
Practice Address - Phone:916-988-2212
Practice Address - Fax:916-988-8578
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA5766T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT10111Medicare UPIN
CAFR844AMedicare PIN