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NPI Code Detail

MEDICARE: DR. GARY JAMES AVALLONE OD

MEDICARE: DR. GARY JAMES AVALLONE OD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist927-032TLA
2152W00000XOptometrist3151TTX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1457300261
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GARY JAMES AVALLONE OD
Provider Business Mailing Address
First Line : 144 FOX RUN
Second Line :
City : WEST MONROE
State : LA
Zip : 71291-8137
Country : US
Telephone Number : 318-397-2041
Fax Number : 318-396-8936
Provider Business Practice Location Address
First Line : 911 TECH DRIVE
Second Line :
City : RUSTON
State : LA
Zip : 71270-0701
Country : US
Telephone Number : 318-251-9095
Fax Number : 318-251-1705
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2006
Last Update Date : 09/18/2008

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