Provider Demographics
NPI:1487862256
Name:GASTON OPTOMETRY, P.C.
Entity Type:Organization
Organization Name:GASTON OPTOMETRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:M
Authorized Official - Last Name:GASTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:816-734-0319
Mailing Address - Street 1:10395A N CHERRY DR APT 3D
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64155-1874
Mailing Address - Country:US
Mailing Address - Phone:816-734-0319
Mailing Address - Fax:
Practice Address - Street 1:3022 S BELT HWY
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64503-1547
Practice Address - Country:US
Practice Address - Phone:816-232-5514
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004023125152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty