Provider Demographics
NPI:1568787224
Name:GASS, EDWARD MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:MICHAEL
Last Name:GASS
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 1:1900 MCKINNEY WAY
Mailing Address - Street 2:APT.22F
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-4480
Mailing Address - Country:US
Mailing Address - Phone:562-694-6660
Mailing Address - Fax:
Practice Address - Street 1:1900 MCKINNEY WAY
Practice Address - Street 2:APT.22F
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-4480
Practice Address - Country:US
Practice Address - Phone:562-694-6660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5946T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist