Gary G Deckelboim MD PA

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

License

J0940 Issued in TX

Legal business name

GARY G DECKELBOIM MD PA

Practice address

330 E Loop 281
Longview, TX 75605-7912

Phone

(903) 758-7385

Fax

(903) 758-3800

NPI assigned

Mar 30, 2007

Last updated

Feb 21, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Gary G Deckelboim, MD PA

Title

Owner Opthalmologist

Phone

(903) 758-3800

Specialties & licenses 1

Addresses

Other names 1

• Gary G Deckelboim MD Other name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203552000000",
    "number": "1447370739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 E LOOP 281",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756057912",
            "telephone_number": "903-758-7385",
            "fax_number": "903-758-3800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 E LOOP 281",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756057912",
            "telephone_number": "903-758-7385",
            "fax_number": "903-758-3800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GARY G DECKELBOIM MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-30",
        "last_updated": "2008-02-21",
        "status": "A",
        "authorized_official_last_name": "DECKELBOIM",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER OPTHALMOLOGIST",
        "authorized_official_telephone_number": "903-758-3800",
        "authorized_official_credential": "MD PA"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "TX",
            "license": "J0940",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gary G Deckelboim MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Megan Garrison
• Gary F Mapes DDS PA
• Diana Isabel Garza, OT
• Lauren Gaspard
• Leah Gatdula, MD
• Loui Chan Gatdula, MD
• Jeffrey Gates, P.T.

• Eyewear Supplier in Longview, TX
• Providers in Longview, TX by specialty
• Eyewear Supplier in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.