Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OPT5904T | CA |
NPI | 1003960048 |
---|---|
Provider Name | Gary Duane Maas |
First Address | Vallejo, CA 94589-2441 |
Second Address | Vallejo, CA 94589 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 08/07/2007 |