Provider Demographics
NPI:1851358717
Name:RESPICIO, S. GABRIEL III (OD)
Entity Type:Individual
Prefix:
First Name:S. GABRIEL
Middle Name:
Last Name:RESPICIO
Suffix:III
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 ALFRED NOBEL DR
Mailing Address - Street 2:SUITE 117
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-1838
Mailing Address - Country:US
Mailing Address - Phone:510-964-1484
Mailing Address - Fax:510-724-3944
Practice Address - Street 1:500 ALFRED NOBEL DR
Practice Address - Street 2:SUITE 117
Practice Address - City:HERCULES
Practice Address - State:CA
Practice Address - Zip Code:94547-1838
Practice Address - Country:US
Practice Address - Phone:510-964-1484
Practice Address - Fax:510-724-3944
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA09510T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU32449Medicare UPIN
CAZZZ02152ZMedicare ID - Type Unspecified