Provider Demographics
NPI:1407950041
Name:SEAL, GARY ALVIS (OD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:ALVIS
Last Name:SEAL
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 1:3905 BELLA VISTA LOOP
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-8723
Mailing Address - Country:US
Mailing Address - Phone:254-285-6316
Mailing Address - Fax:
Practice Address - Street 1:416 NORTH GRAY ST
Practice Address - Street 2:KILLEEN EYECARE CENTER
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76541
Practice Address - Country:US
Practice Address - Phone:254-634-7805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2079152W00000X
TX4706TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist