Provider Demographics
NPI:1376544635
Name:GAGE, GARY JAMES (OD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:JAMES
Last Name:GAGE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:808 SAINT VINCENT ST
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:TX
Mailing Address - Zip Code:78629-4624
Mailing Address - Country:US
Mailing Address - Phone:830-672-6293
Mailing Address - Fax:830-672-6785
Practice Address - Street 1:305 SAINT LAWRENCE ST
Practice Address - Street 2:#1598
Practice Address - City:GONZALES
Practice Address - State:TX
Practice Address - Zip Code:78629-3935
Practice Address - Country:US
Practice Address - Phone:830-672-6521
Practice Address - Fax:830-672-6785
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2776TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT13364Medicare UPIN
TX00E34JMedicare ID - Type Unspecified