GARY G DECKELBOIM MD PA NPI 1447370739

NPI Information

NPI: 1447370739
Provider Name: GARY G DECKELBOIM MD PA

Other Name: GARY G DECKELBOIM MD

Classification: Eyewear Supplier - 332H00000X
Entity Type: Organization
Address:
330 E LOOP 281
LONGVIEW, TX
ZIP 75605
Phone: (903) 758-7385
Get Directions

GARY G DECKELBOIM MD PA is an eyewear supplier in Longview, TX. The provider is an organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist. GARY G DECKELBOIM MD PA NPI is 1447370739. The provider is registered as an organization entity type.
The provider Other Name Is Gary G Deckelboim Md.

The provider's business location address is:

330 E LOOP 281
LONGVIEW, TX
ZIP 75605-912
Phone: (903) 758-7385
Fax: (903) 758-3800

The provider's authorized official is Gary G Deckelboim .
The authorized official title is Owner Opthalmologist and has the following contact phone number (903) 758-3800.

The enumeration date for this NPI number is 3/30/2007 and was last updated on 2/21/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	332H00000X	Eyewear Supplier		J0940	TEXAS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	A61669	MEDICARE UPIN
2	1243970001	MEDICARE ID-TYPE UNSPECIFIED	TEXAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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