MEDICARE: CALIFORNIA OPHTHALMIC LASER ASSOCIATES, MEDICAL PC

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

General Provider Information

NPI Number	:	1609083435
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALIFORNIA OPHTHALMIC LASER ASSOCIATES, MEDICAL PC

Provider Business Mailing Address
First Line	:	303 W JOAQUIN AVE
Second Line	:	SUITE 250
City	:	SAN LEANDRO
State	:	CA
Zip	:	94577-3642
Country	:	US
Telephone Number	:	510-895-9657
Fax Number	:	510-895-9680

Provider Business Practice Location Address
First Line	:	303 W JOAQUIN AVE
Second Line	:	SUITE 250
City	:	SAN LEANDRO
State	:	CA
Zip	:	94577-3642
Country	:	US
Telephone Number	:	510-895-9657
Fax Number	:	510-895-9680

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. HAROLD GAMBILL
Credential	:	M.D.
Telephone Number	:	408-398-6066

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	08/22/2020

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