MEDICARE: AUSTIN GREGORY

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
1	152W00000X	Optometrist	14783	CA

General Provider Information

NPI Number	:	1861829749
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUSTIN GREGORY

Provider Business Mailing Address
First Line	:	2114 UNION ST APT A
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94123-4004
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2114 UNION ST APT A
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94123-4004
Country	:	US
Telephone Number	:	805-234-0528
Fax Number	:

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	AUSTIN THOMAS GREGORY
Credential	:
Telephone Number	:	805-234-0528

Provider Enumeration Date	:	10/08/2013
Last Update Date	:	10/08/2013

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