MEDICARE: DR. GARY W ASANO 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	06394T	CA

General Provider Information

NPI Number	:	1417950924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY W ASANO OD

Provider Business Mailing Address
First Line	:	10951 CHERRY ST
Second Line	:	STE 101
City	:	LOS ALAMITOS
State	:	CA
Zip	:	90720-2401
Country	:	US
Telephone Number	:	562-430-6161
Fax Number	:	562-598-3041

Provider Business Practice Location Address
First Line	:	10951 CHERRY ST
Second Line	:	STE 101
City	:	LOS ALAMITOS
State	:	CA
Zip	:	90720-2401
Country	:	US
Telephone Number	:	562-430-6161
Fax Number	:	562-598-3041

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

Provider Enumeration Date	:	05/30/2005
Last Update Date	:	07/14/2009

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