Provider Demographics
NPI:1861562761
Name:EPSTEIN, GORDON LEWIS (OD)
Entity type:Individual
Prefix:DR
First Name:GORDON
Middle Name:LEWIS
Last Name:EPSTEIN
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 1:1598 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-4465
Mailing Address - Country:US
Mailing Address - Phone:510-895-2116
Mailing Address - Fax:510-895-2316
Practice Address - Street 1:1598 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4465
Practice Address - Country:US
Practice Address - Phone:510-895-2116
Practice Address - Fax:510-895-2316
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA06209T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0062090Medicaid
CASD0062091Medicare PIN
CASD0062090Medicaid