Provider Demographics
NPI:1902937923
Name:LACAYO, GASTON OCTAVIO III (MD)
Entity Type:Individual
Prefix:
First Name:GASTON
Middle Name:OCTAVIO
Last Name:LACAYO
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8940 N KENDALL DR
Mailing Address - Street 2:SUITE 400E
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2148
Mailing Address - Country:US
Mailing Address - Phone:305-598-2020
Mailing Address - Fax:305-270-6430
Practice Address - Street 1:8940 N KENDALL DR
Practice Address - Street 2:SUITE 400E
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2148
Practice Address - Country:US
Practice Address - Phone:305-598-2020
Practice Address - Fax:305-270-6430
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-115366207W00000X
FLME95390207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty