Provider Demographics
NPI:1942368972
Name:POLAN, GARY DAVID (OD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:DAVID
Last Name:POLAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:970 MONUMENT ST
Mailing Address - Street 2:STE 102
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-3860
Mailing Address - Country:US
Mailing Address - Phone:310-459-0055
Mailing Address - Fax:310-459-4070
Practice Address - Street 1:970 MONUMENT ST
Practice Address - Street 2:STE 102
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-3860
Practice Address - Country:US
Practice Address - Phone:310-459-0055
Practice Address - Fax:310-459-4070
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CACA8007TPL152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy