Provider Demographics
NPI:1689609117
Name:LARRY N. GATES O.D.,P.C.
Entity Type:Organization
Organization Name:LARRY N. GATES O.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:N
Authorized Official - Last Name:GATES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:830-334-8077
Mailing Address - Street 1:315 E COLORADO ST
Mailing Address - Street 2:
Mailing Address - City:PEARSALL
Mailing Address - State:TX
Mailing Address - Zip Code:78061-3207
Mailing Address - Country:US
Mailing Address - Phone:830-334-8077
Mailing Address - Fax:830-334-8079
Practice Address - Street 1:315 E COLORADO ST
Practice Address - Street 2:
Practice Address - City:PEARSALL
Practice Address - State:TX
Practice Address - Zip Code:78061-3207
Practice Address - Country:US
Practice Address - Phone:830-334-8077
Practice Address - Fax:830-334-8079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2313TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX019182701Medicaid
TX019182701Medicaid
TX0605050002Medicare NSC
TX00E03YMedicare PIN