Provider Demographics
NPI:1245276575
Name:LOUIE, GERALD CURTIS (OD)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:CURTIS
Last Name:LOUIE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:5080 FOOTHILLS BLVD
Mailing Address - Street 2:STE 2
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747
Mailing Address - Country:US
Mailing Address - Phone:916-784-6508
Mailing Address - Fax:916-784-8095
Practice Address - Street 1:5080 FOOTHILLS BLVD
Practice Address - Street 2:STE 2
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747
Practice Address - Country:US
Practice Address - Phone:916-784-6508
Practice Address - Fax:916-784-8095
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10208T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0102080Medicaid
CASD0102080Medicaid
SD0102081Medicare ID - Type Unspecified