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General NPI Number Information
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NPI Number | 1790838092
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Entity Type | Individual
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Provider Name | GREGORY K.W. KO O.D.
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Gender | Male
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5580 SPRINGDALE AVE STE E
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City | PLEASANTON
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State | CA
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Zip | 94588-3707
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Country | US
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Telephone | 925-463-3100
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Fax |
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Provider Business Mailing Address
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Address Line | 4180 LARK CT
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City | FREMONT
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State | CA
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Zip | 94555-1116
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Country | US
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Telephone | 510-477-0437
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 5976T
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License Number State | CA
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