Provider Demographics
NPI:1407959406
Name:KASOVICH, GABRIEL KEVIN (OD)
Entity Type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:KEVIN
Last Name:KASOVICH
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 1:4324 VETERANS MEMORIAL BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-5445
Mailing Address - Country:US
Mailing Address - Phone:504-455-9825
Mailing Address - Fax:504-883-7669
Practice Address - Street 1:4324 VETERANS MEMORIAL BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-5445
Practice Address - Country:US
Practice Address - Phone:504-455-9825
Practice Address - Fax:504-883-7669
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1394-524T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1720712Medicaid
LA1720712Medicaid
LA4R110D624Medicare ID - Type Unspecified