Healthcare Provider Details

I. General information

NPI: 1427028562
Provider Name (Legal Business Name): GARY MICHAEL LOVCIK O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 10/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5701 E SANTA ANA CANYON RD SUITE H
ANAHEIM HILLS CA
92807-3231
US

IV. Provider business mailing address

5701 E SANTA ANA CANYON RD
ANAHEIM HILLS CA
92807-3231
US

V. Phone/Fax

Practice location:
  • Phone: 714-637-1640
  • Fax: 714-998-8781
Mailing address:
  • Phone: 714-637-1640
  • Fax: 714-998-8781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT 8273 TPL
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: