MEDICARE: GARY LOWELL ENGLUND OD

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	6208T	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184651390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY LOWELL ENGLUND OD

Provider Business Mailing Address
First Line	:	PO BOX 6040
Second Line	:	1112 VINE ST
City	:	PASO ROBLES
State	:	CA
Zip	:	93446
Country	:	US
Telephone Number	:	805-528-5333
Fax Number	:	805-528-7723

Provider Business Practice Location Address
First Line	:	2231 BAYVIEW HEIGHTS DR
Second Line	:
City	:	LOS OSOS
State	:	CA
Zip	:	93402-3900
Country	:	US
Telephone Number	:	805-528-5333
Fax Number	:	805-528-7723

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	02/24/2017

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