Individual
MR. GARY DANIEL WALDROP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OPTICIAN
Contact information
Practice address
4601 SHASTA DAM BLVD, SHASTA LAKE, CA 96019-9413
(530) 275-8581
(530) 275-8596
Mailing address
4601 SHASTA DAM BLVD, SHASTA LAKE, CA 96019-9413
(530) 275-8581
(530) 275-8596
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
141463
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9419
MEDICAL EYE SERVICES
CA
01
—
CA4661
EYE MED PROVIDER NUMBER
CA
05
—
DX067260F
—
CA
Enumeration date
03/16/2007
Last updated
07/08/2007
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