Healthcare Provider Details

I. General information

NPI: 1285607531
Provider Name (Legal Business Name): GARY ROBERT STOCKER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 E CALAVERAS BLVD
MILPITAS CA
95035-5543
US

IV. Provider business mailing address

1301 E CALAVERAS BLVD
MILPITAS CA
95035-5543
US

V. Phone/Fax

Practice location:
  • Phone: 408-263-2040
  • Fax: 408-946-2020
Mailing address:
  • Phone: 408-263-2040
  • Fax: 408-946-2020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number7362 T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: