Provider Demographics
NPI:1417950924
Name:ASANO, GARY W (OD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:W
Last Name:ASANO
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:10951 CHERRY ST
Mailing Address - Street 2:STE 101
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2401
Mailing Address - Country:US
Mailing Address - Phone:562-430-6161
Mailing Address - Fax:562-598-3041
Practice Address - Street 1:10951 CHERRY ST
Practice Address - Street 2:STE 101
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2401
Practice Address - Country:US
Practice Address - Phone:562-430-6161
Practice Address - Fax:562-598-3041
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-30
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA06394T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OP6394Medicare UPIN