Provider Demographics
NPI:1780214403
Name:BATES, GARY ALAN (RDO)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:ALAN
Last Name:BATES
Suffix:
Gender:M
Credentials:RDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2540 ZANELLA WAY STE 10
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-7194
Mailing Address - Country:US
Mailing Address - Phone:530-413-9627
Mailing Address - Fax:530-413-9628
Practice Address - Street 1:2540 ZANELLA WAY STE 10
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-7194
Practice Address - Country:US
Practice Address - Phone:530-399-0217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-22
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA71094156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician