Provider Demographics
NPI:1487139697
Name:SAELEE, GARY FONG (OD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:FONG
Last Name:SAELEE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9263 N SAYBROOK DR APT 243
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-0824
Mailing Address - Country:US
Mailing Address - Phone:916-539-6517
Mailing Address - Fax:
Practice Address - Street 1:2705 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:CA
Practice Address - Zip Code:93662-3389
Practice Address - Country:US
Practice Address - Phone:559-891-9003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-03
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34148TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist