George R Gage, O.D.
Individual provider Active NPI Optometrist · Paola, KS
NPI 1528034741 · NPPES record last updated Dec 10, 2013
Key facts
- NPI
- 1528034741
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 1033-3 (KS)
- Practice address
- 2 S Silver St
Paola, KS 66071-1469 - Phone
- (913) 294-2300
- Fax
- (913) 294-2302
- NPI assigned
- Feb 27, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1033-3 | KS | MD | Optometrist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1033-3 | KS | Yes |
Addresses
Primary practice location
2 S Silver St
Paola, KS 66071-1469
Mailing address
2 S Silver St
Paola, KS 66071-1469
Phone (913) 294-2300
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100090930A | Medicaid | KS |
Other providers in Paola, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 10, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.