Provider Demographics
NPI:1831537851
Name:GAUBA, AJAY
Entity type:Individual
Prefix:MR
First Name:AJAY
Middle Name:
Last Name:GAUBA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2530 COUNTRY TOP TRL
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020-8838
Mailing Address - Country:US
Mailing Address - Phone:610-866-6682
Mailing Address - Fax:
Practice Address - Street 1:204 EXTON SQUARE MALL
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2442
Practice Address - Country:US
Practice Address - Phone:610-363-1164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE00008371T152W00000X
156F00000X, 156FC0800X, 156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No156F00000XEye and Vision Services ProvidersTechnician/Technologist
No156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact Lens
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician