Healthcare Provider Details

I. General information

NPI: 1972725760
Provider Name (Legal Business Name): GINA MARIA DAY O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 10/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 LARKSPUR LANDING CIR
LARKSPUR CA
94939-1802
US

IV. Provider business mailing address

2005 LARKSPUR LANDING CIR
LARKSPUR CA
94939-1802
US

V. Phone/Fax

Practice location:
  • Phone: 415-925-9091
  • Fax: 415-925-9092
Mailing address:
  • Phone: 415-925-9091
  • Fax: 415-925-9092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number10121T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: