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Organization

DR. GARY D. POLAN, OD

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. GARY POLAN (OPTOMETRIST)
(310) 459-0055
Entity
Organization

Contact information

Practice address
970 MONUMENT ST STE 102, PACIFIC PALISADES, CA 90272-3860
(310) 459-0055
Mailing address
970 MONUMENT ST STE 102, PACIFIC PALISADES, CA 90272-3860

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
152WS0006X
Sports Vision Optometrist
152WV0400X
Vision Therapy Optometrist

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1184288862
NPPES
01
1942368972
NPPES
Enumeration date
05/13/2020
Last updated
05/13/2020
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