Provider Demographics
NPI:1538130695
Name:GATES, LARRY NEAL (OD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:NEAL
Last Name:GATES
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 1:315 E COLORADO ST
Mailing Address - Street 2:
Mailing Address - City:PEARSALL
Mailing Address - State:TX
Mailing Address - Zip Code:78061-3207
Mailing Address - Country:US
Mailing Address - Phone:830-334-8077
Mailing Address - Fax:830-334-8079
Practice Address - Street 1:315 E COLORADO ST
Practice Address - Street 2:
Practice Address - City:PEARSALL
Practice Address - State:TX
Practice Address - Zip Code:78061-3207
Practice Address - Country:US
Practice Address - Phone:830-334-8077
Practice Address - Fax:830-334-8079
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2313TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX060505002OtherMEDICARE RAILROAD
TX112322604Medicaid
TXT13413Medicare UPIN
TX00E03YMedicare PIN