MEDICARE: GARY L. ENGLUND, OD, APC

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		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

General Provider Information

NPI Number	:	1356530638
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARY L. ENGLUND, OD, APC

Provider Business Mailing Address
First Line	:	2238 BAYVIEW HEIGHTS DR STE E
Second Line	:
City	:	LOS OSOS
State	:	CA
Zip	:	93402-3932
Country	:	US
Telephone Number	:	805-528-5333
Fax Number	:

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	:

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	DIANA ALVISO
Credential	:
Telephone Number	:	805-238-1001

Provider Enumeration Date	:	10/23/2007
Last Update Date	:	10/25/2024

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