Provider Demographics
NPI:1467633420
Name:GREGORY K WACASEY, OD
Entity Type:Organization
Organization Name:GREGORY K WACASEY, OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:K
Authorized Official - Last Name:WACASEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:903-663-1550
Mailing Address - Street 1:307 W LOOP 281
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-4442
Mailing Address - Country:US
Mailing Address - Phone:903-663-1550
Mailing Address - Fax:903-663-9038
Practice Address - Street 1:307 W LOOP 281
Practice Address - Street 2:SUITE 2B
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-4442
Practice Address - Country:US
Practice Address - Phone:903-663-1550
Practice Address - Fax:903-663-9038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7108TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty