Provider Demographics
NPI:1598802282
Name:EMPEY, GREGORY MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:MICHAEL
Last Name:EMPEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 SYLVANIA AVE
Mailing Address - Street 2:OPTOMETRY DEPARTMENT
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-2161
Mailing Address - Country:US
Mailing Address - Phone:831-460-1480
Mailing Address - Fax:831-460-1479
Practice Address - Street 1:220 SYLVANIA AVE
Practice Address - Street 2:OPTOMETRY DEPARTMENT
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-2161
Practice Address - Country:US
Practice Address - Phone:831-460-1480
Practice Address - Fax:831-460-1479
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11630T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11630TOtherOPTOMETRY LICENSE
CAU95993Medicare UPIN
CA11630TOtherOPTOMETRY LICENSE