Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OPT8724T | CA |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 8724 | CA |
NPI | 1255317780 |
---|---|
Provider Name | Dr. Eric E Gaylord |
First Address | Los Angeles, CA 90008-3685 |
Second Address | Los Angeles, CA 90008-3685 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2005 |
Last Update Date | 13/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
SD0087240 | (05) | CA |
T70281 | (02) | CA |