Healthcare Provider Details

I. General information

NPI: 1922099639
Provider Name (Legal Business Name): BRIAN G B GASTER OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 01/17/2022
Certification Date: 01/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E BEAU ST
WASHINGTON PA
15301-6661
US

IV. Provider business mailing address

9725 PHOENICIAN AVE
LAS VEGAS NV
89147-8337
US

V. Phone/Fax

Practice location:
  • Phone: 724-228-2982
  • Fax:
Mailing address:
  • Phone: 814-931-5221
  • Fax: 702-202-6110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG000418
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number898
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: