Organization
GARY L ETTING OD AN OPTOMETRIC CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY L ETTING OD (OWNER)
(818) 344-3937
Entity
Organization
Contact information
Practice address
6345 BALBOA BLVD, BLDG 3 SUITE 250, ENCINO, CA 91316
(818) 344-3937
(818) 344-1229
Mailing address
6345 BALBOA BLVD, BLDG 3 SUITE 250, ENCINO, CA 91316
(818) 344-3937
(818) 344-1229
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
OPT 5519 T
CA
152W00000X
Optometrist
Primary
OPT5519
CA
152WV0400X
Vision Therapy Optometrist
OPT 5519 T
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
WOP5519A
OTHER MEDICARE PTAN
CA
Enumeration date
08/19/2006
Last updated
12/02/2014
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