Healthcare Provider Details

I. General information

NPI: 1689609117
Provider Name (Legal Business Name): LARRY N. GATES O.D.,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 11/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 E COLORADO ST
PEARSALL TX
78061-3207
US

IV. Provider business mailing address

315 E COLORADO ST
PEARSALL TX
78061-3207
US

V. Phone/Fax

Practice location:
  • Phone: 830-334-8077
  • Fax: 830-334-8079
Mailing address:
  • Phone: 830-334-8077
  • Fax: 830-334-8079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2313TG
License Number StateTX

VIII. Authorized Official

Name: DR. LARRY N. GATES
Title or Position: PRESIDENT
Credential: O.D.
Phone: 830-334-8077