Provider Demographics
NPI:1730265141
Name:CONTOS, GEORGE PETER (OD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:PETER
Last Name:CONTOS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 ESCOBAR ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-5713
Mailing Address - Country:US
Mailing Address - Phone:510-789-7053
Mailing Address - Fax:
Practice Address - Street 1:462 E CALAVERAS BLVD
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-5412
Practice Address - Country:US
Practice Address - Phone:408-262-4178
Practice Address - Fax:408-262-5351
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6424 T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA77-0012970OtherFEIN
CASD00642400Medicaid
CASD00642400Medicare ID - Type Unspecified
CASD00642400Medicaid