Provider Demographics
NPI:1952569634
Name:OPTOMETRIC SPECIALTIES INC
Entity Type:Organization
Organization Name:OPTOMETRIC SPECIALTIES INC
Other - Org Name:GARDEN GROVE OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:E
Authorized Official - Last Name:GAYLORD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:714-530-5050
Mailing Address - Street 1:12902 BROOKHURST ST STE A
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-4881
Mailing Address - Country:US
Mailing Address - Phone:714-530-5050
Mailing Address - Fax:
Practice Address - Street 1:12902 BROOKHURST ST STE A
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-4881
Practice Address - Country:US
Practice Address - Phone:714-530-5050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty