Provider Demographics
NPI:1538347042
Name:GARY J GAGE
Entity type:Organization
Organization Name:GARY J GAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:GAGE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:830-672-6521
Mailing Address - Street 1:PO BOX 1598
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:TX
Mailing Address - Zip Code:78629-1098
Mailing Address - Country:US
Mailing Address - Phone:830-672-6521
Mailing Address - Fax:
Practice Address - Street 1:305 SAINT LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:TX
Practice Address - Zip Code:78629-3935
Practice Address - Country:US
Practice Address - Phone:830-672-6521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2776TG332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT13364Medicare UPIN
TX0303810001Medicare NSC