Provider Demographics
NPI:1013922467
Name:GEALY, WILLIAM JAMES JR (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JAMES
Last Name:GEALY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:W
Other - Middle Name:JAMES
Other - Last Name:GEALY
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:234 HEATHER CT
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-8765
Mailing Address - Country:US
Mailing Address - Phone:805-434-5970
Mailing Address - Fax:805-434-5973
Practice Address - Street 1:234 HEATHER CT
Practice Address - Street 2:SUITE 102
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465
Practice Address - Country:US
Practice Address - Phone:805-434-5970
Practice Address - Fax:805-434-5973
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG43671207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G436710Medicaid
CAWG43671BMedicare ID - Type Unspecified
CA00G436710Medicaid
CA180023851Medicare ID - Type UnspecifiedRR MEDICARE
CAA49424Medicare UPIN