Provider Demographics
NPI:1275806614
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 INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JEFFERY
Authorized Official - Last Name:GAJDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-877-2020
Mailing Address - Street 1:5889 CLARK ROAD
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969
Mailing Address - Country:US
Mailing Address - Phone:530-877-2020
Mailing Address - Fax:530-877-4641
Practice Address - Street 1:5889 CLARK ROAD
Practice Address - Street 2:
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969
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:2012-02-15
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG88865332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6684150001Medicare NSC