Provider Demographics
NPI:1356530638
Name:GARY L. ENGLUND, OD, APC
Entity type:Organization
Organization Name:GARY L. ENGLUND, OD, APC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVISO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-238-1001
Mailing Address - Street 1:2238 BAYVIEW HEIGHTS DR STE E
Mailing Address - Street 2:
Mailing Address - City:LOS OSOS
Mailing Address - State:CA
Mailing Address - Zip Code:93402-3932
Mailing Address - Country:US
Mailing Address - Phone:805-528-5333
Mailing Address - Fax:
Practice Address - Street 1:2231 BAYVIEW HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:LOS OSOS
Practice Address - State:CA
Practice Address - Zip Code:93402-3900
Practice Address - Country:US
Practice Address - Phone:805-528-5333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0062080Medicaid
CA0312300001Medicare NSC
CAWY7320Medicare PIN