Provider Demographics
NPI:1972555746
Name:MUKAI, GARY TERUO (OD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:TERUO
Last Name:MUKAI
Suffix:
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 1:7215 N 1ST ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2985
Mailing Address - Country:US
Mailing Address - Phone:559-226-3937
Mailing Address - Fax:559-226-8305
Practice Address - Street 1:7215 N 1ST ST
Practice Address - Street 2:SUITE 101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2985
Practice Address - Country:US
Practice Address - Phone:559-226-3937
Practice Address - Fax:559-226-8305
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT5743TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3356OtherMEDICAL EYE SERVICES INS
CASD0057430Medicaid
CA194427OtherSAFEGUARD INS
CA3356OtherMEDICAL EYE SERVICES INS
CASD0057430Medicare ID - Type Unspecified