Provider Demographics
NPI:1437231461
Name:COLE, GARY ALAN (OD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:ALAN
Last Name:COLE
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 1:6680 NE 159TH AVE.
Mailing Address - Street 2:SUITE #102
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-3880
Mailing Address - Country:US
Mailing Address - Phone:360-449-3937
Mailing Address - Fax:360-449-3094
Practice Address - Street 1:6680 NE 159TH AVE.
Practice Address - Street 2:SUITE #102
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682-3880
Practice Address - Country:US
Practice Address - Phone:360-449-3937
Practice Address - Fax:360-449-3094
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3402TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2023828Medicaid
WA2023828Medicaid
WAAB15547Medicare ID - Type Unspecified