Provider Demographics
NPI:1528034741
Name:GAGE, GEORGE R (OD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:R
Last Name:GAGE
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 1:2 S SILVER ST
Mailing Address - Street 2:
Mailing Address - City:PAOLA
Mailing Address - State:KS
Mailing Address - Zip Code:66071-1469
Mailing Address - Country:US
Mailing Address - Phone:913-294-2300
Mailing Address - Fax:913-294-2302
Practice Address - Street 1:2 S SILVER ST
Practice Address - Street 2:
Practice Address - City:PAOLA
Practice Address - State:KS
Practice Address - Zip Code:66071-1469
Practice Address - Country:US
Practice Address - Phone:913-294-2300
Practice Address - Fax:913-294-2302
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1033-3152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100090930AMedicaid
KS005289Medicare ID - Type UnspecifiedMEDICARE
KST43744Medicare UPIN
KS0624520001Medicare NSC