Provider Demographics
NPI:1710151600
Name:GAILA J AUSTIN OD PC
Entity Type:Organization
Organization Name:GAILA J AUSTIN OD PC
Other - Org Name:GAILA J CALDWELL AUSTIN OD
Other - Org Type:Other Name
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:GAILA
Authorized Official - Middle Name:J
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:719-336-3969
Mailing Address - Street 1:206 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:CO
Mailing Address - Zip Code:81052-2820
Mailing Address - Country:US
Mailing Address - Phone:719-336-3969
Mailing Address - Fax:719-336-1007
Practice Address - Street 1:206 S 4TH ST
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:CO
Practice Address - Zip Code:81052-2820
Practice Address - Country:US
Practice Address - Phone:719-336-3969
Practice Address - Fax:719-336-1007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1665152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO5609010001Medicare NSC
COU53322Medicare UPIN
COC804703Medicare PIN