Provider Demographics
NPI:1295864890
Name:GAYED, OSAMA
Entity Type:Individual
Prefix:
First Name:OSAMA
Middle Name:
Last Name:GAYED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W WILLOW ST
Mailing Address - Street 2:SUITE # 7
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-2831
Mailing Address - Country:US
Mailing Address - Phone:562-427-5527
Mailing Address - Fax:562-989-1557
Practice Address - Street 1:500 W WILLOW ST.
Practice Address - Street 2:SUITE # 7
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2831
Practice Address - Country:US
Practice Address - Phone:562-427-5527
Practice Address - Fax:562-989-1557
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6215156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADX006005FMedicaid
CA5140870001Medicare ID - Type UnspecifiedVISION