Provider Demographics
NPI:1487730651
Name:AVILA, GABRIEL (OD)
Entity type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:
Last Name:AVILA
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 1:4734 S 14TH
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-4733
Mailing Address - Country:US
Mailing Address - Phone:325-692-9596
Mailing Address - Fax:325-690-6191
Practice Address - Street 1:4734 S 14TH
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-4733
Practice Address - Country:US
Practice Address - Phone:325-692-9596
Practice Address - Fax:325-690-6191
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6293TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U91992Medicare UPIN
TX8B2300Medicare PIN