Provider Demographics
NPI:1376513259
Name:GORE, ANDREW (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:GORE
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 1:301 E COLORADO BLVD
Mailing Address - Street 2:#528
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1915
Mailing Address - Country:US
Mailing Address - Phone:626-796-5533
Mailing Address - Fax:626-796-8954
Practice Address - Street 1:301 E COLORADO BLVD
Practice Address - Street 2:#528
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1915
Practice Address - Country:US
Practice Address - Phone:626-796-5533
Practice Address - Fax:626-796-8954
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11251T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU85385Medicare UPIN
CAOP11251Medicare PIN