Provider Demographics
NPI:1255457859
Name:GILBERT, DAN WESLEY (OD)
Entity type:Individual
Prefix:DR
First Name:DAN
Middle Name:WESLEY
Last Name:GILBERT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4940 IRVINE BLVD
Mailing Address - Street 2:STE#102
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-1959
Mailing Address - Country:US
Mailing Address - Phone:714-730-9580
Mailing Address - Fax:714-730-9517
Practice Address - Street 1:4940 IRVINE BLVD
Practice Address - Street 2:STE#102
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92620-1959
Practice Address - Country:US
Practice Address - Phone:714-730-9580
Practice Address - Fax:714-730-9517
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA06927152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist