Provider Demographics
NPI:1427028562
Name:LOVCIK, GARY MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:MICHAEL
Last Name:LOVCIK
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 1:5701 E SANTA ANA CANYON RD
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92807-3231
Mailing Address - Country:US
Mailing Address - Phone:714-637-1640
Mailing Address - Fax:714-998-8781
Practice Address - Street 1:5701 E SANTA ANA CANYON RD
Practice Address - Street 2:SUITE H
Practice Address - City:ANAHEIM HILLS
Practice Address - State:CA
Practice Address - Zip Code:92807-3231
Practice Address - Country:US
Practice Address - Phone:714-637-1640
Practice Address - Fax:714-998-8781
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 8273 TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFV147AMedicare PIN