Provider Demographics
NPI:1649229527
Name:PELOSI, GAIL S (OD)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:S
Last Name:PELOSI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 WILLIAM PENN HWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-5283
Mailing Address - Country:US
Mailing Address - Phone:610-253-0750
Mailing Address - Fax:610-253-2121
Practice Address - Street 1:2925 WILLIAM PENN HWY
Practice Address - Street 2:SUITE 300
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-5283
Practice Address - Country:US
Practice Address - Phone:610-253-0750
Practice Address - Fax:610-253-2121
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG 001081152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3474959OtherAETNA OPTOMETRIST
PAPE 660212OtherHIGHMARK/BLU SHIELD
PA20349OtherSPECTERA OPTOMETRIST
PAPA 1081OtherEYEMED OPTOMETRIST
PA44784OtherDAVIS VISION
PA1252700OtherMAID
PA397501OtherNAT'L VISION ADMINISTRATO
PA6102530750OtherVSP
PAPE 660212OtherHIGHMARK/BLU SHIELD
PAU17434Medicare UPIN