Provider Demographics
NPI:1811014715
Name:GOR, ANITA (OD)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:
Last Name:GOR
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 1:4 CARRIAGE LN
Mailing Address - Street 2:
Mailing Address - City:SCOTTS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95066-4700
Mailing Address - Country:US
Mailing Address - Phone:831-332-2661
Mailing Address - Fax:
Practice Address - Street 1:2040 CALIFORNIA AVE. TARGET
Practice Address - Street 2:TARGET OPTICAL
Practice Address - City:SAND CITY
Practice Address - State:CA
Practice Address - Zip Code:93955
Practice Address - Country:US
Practice Address - Phone:831-392-1991
Practice Address - Fax:831-393-9329
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT12298TLG152WV0400X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGZ726AMedicare UPIN
CAV04770Medicare UPIN