Provider Demographics
NPI:1720110372
Name:NOVAK, GREGORY JAMES (OD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:JAMES
Last Name:NOVAK
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 1:981 VIA CAMPOBELLO
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-1227
Mailing Address - Country:US
Mailing Address - Phone:805-692-9269
Mailing Address - Fax:
Practice Address - Street 1:3845 STATE ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-3111
Practice Address - Country:US
Practice Address - Phone:805-682-3998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7300TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist