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General NPI Number Information
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NPI Number | 1841812716
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Entity Type | Organization
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Legal Business Name | DR. GARY D. POLAN, OD
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Dates
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Enumeration Date | 05/13/2020
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Last Update Date | 05/13/2020
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Provider Practice Location Address
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Address Line | 970 MONUMENT ST STE 102
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City | PACIFIC PALISADES
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State | CA
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Zip | 90272-3860
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Country | US
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Telephone | 310-459-0055
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Fax |
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Provider Business Mailing Address
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Address Line | 970 MONUMENT ST STE 102
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City | PACIFIC PALISADES
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State | CA
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Zip | 90272-3860
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. GARY POLAN
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Credential |
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Telephone | 310-459-0055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WS0006X
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Taxonomy Name | Sports Vision Optometrist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 152WV0400X
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Taxonomy Name | Vision Therapy Optometrist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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