Provider Demographics
NPI:1679792683
Name:GAN, IRVING (OD)
Entity Type:Individual
Prefix:DR
First Name:IRVING
Middle Name:
Last Name:GAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8925 FINGERBOARD RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-8163
Mailing Address - Country:US
Mailing Address - Phone:301-810-5104
Mailing Address - Fax:301-810-5105
Practice Address - Street 1:8925 FINGERBOARD RD
Practice Address - Street 2:SUITE E
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-8163
Practice Address - Country:US
Practice Address - Phone:301-810-5104
Practice Address - Fax:301-810-5105
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDTA1469152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist