MEDICARE: GARY M. LOUIE O.D. INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OPT 6732 TPA	CA

General Provider Information

NPI Number	:	1134491012
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARY M. LOUIE O.D. INC.

Provider Business Mailing Address
First Line	:	34724 ALVARADO NILES RD
Second Line	:
City	:	UNION CITY
State	:	CA
Zip	:	94587-4502
Country	:	US
Telephone Number	:	510-489-5510
Fax Number	:	510-489-5658

Provider Business Practice Location Address
First Line	:	34724 ALVARADO NILES RD
Second Line	:
City	:	UNION CITY
State	:	CA
Zip	:	94587-4502
Country	:	US
Telephone Number	:	510-489-5510
Fax Number	:	510-489-5658

Authorized Official
Title or Position	:	ACCOUNT MANAGER
Name	:	VICTORIA D FORESTER
Credential	:
Telephone Number	:	510-489-5510

Provider Enumeration Date	:	02/07/2012
Last Update Date	:	02/07/2012

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