Provider Demographics
NPI:1518932805
Name:GAYSO, DON W (OD)
Entity Type:Individual
Prefix:
First Name:DON
Middle Name:W
Last Name:GAYSO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6060 PRIMACY PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5745
Mailing Address - Country:US
Mailing Address - Phone:901-761-4620
Mailing Address - Fax:901-761-3072
Practice Address - Street 1:6060 PRIMACY PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5745
Practice Address - Country:US
Practice Address - Phone:901-761-4620
Practice Address - Fax:901-761-3072
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN2612152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3704130Medicaid
TN3704130Medicaid
TN3946626Medicare ID - Type Unspecified