Healthcare Provider Details

I. General information

NPI: 1831767821
Provider Name (Legal Business Name): OLIVIA K GADA OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 07/03/2024
Certification Date: 05/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8220 SAN PEDRO DR NE STE 220
ALBUQUERQUE NM
87113-2480
US

IV. Provider business mailing address

PO BOX 1506
CHEHALIS WA
98532-0409
US

V. Phone/Fax

Practice location:
  • Phone: 505-797-4466
  • Fax:
Mailing address:
  • Phone: 360-242-3008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0003688
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT-2024-0005
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: