Provider Demographics
NPI:1639206543
Name:GARRELS, GERALD JOHN II (OD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:JOHN
Last Name:GARRELS
Suffix:II
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 1:1055 CROWS NEST WAY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94803-2634
Mailing Address - Country:US
Mailing Address - Phone:510-223-3773
Mailing Address - Fax:
Practice Address - Street 1:11780 SAN PABLO AVE STE B
Practice Address - Street 2:
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530-7103
Practice Address - Country:US
Practice Address - Phone:510-234-1730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 6223152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0062230Medicaid
CASD0062230Medicaid