Provider Demographics
NPI:1467503144
Name:GARY A OSIAS
Entity Type:Organization
Organization Name:GARY A OSIAS
Other - Org Name:PRIMARY EYECARE OPTOMETRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:PHILLIPS
Authorized Official - Last Name:OSIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-581-1553
Mailing Address - Street 1:2687 CASTRO VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-5409
Mailing Address - Country:US
Mailing Address - Phone:510-581-1553
Mailing Address - Fax:510-581-1929
Practice Address - Street 1:2687 CASTRO VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5409
Practice Address - Country:US
Practice Address - Phone:510-581-1553
Practice Address - Fax:510-581-1929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7027T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGSD000960Medicaid
CAGSD000960Medicaid
CA0199780001Medicare NSC