Basic Information
| Provider Information | |||||||||
| NPI: | 1720227515 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GARY M. KAWESCH M.D., INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | LASER EYE CENTER OF SILICON VALLEY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 606 SARATOGA AVE | ||||||||
| Address2: | SUITE 10 | ||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951292000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4082961010 | ||||||||
| FaxNumber: | 4082961018 | ||||||||
| Practice Location | |||||||||
| Address1: | 606 SARATOGA AVE | ||||||||
| Address2: | SUITE 10 | ||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951292000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4082961010 | ||||||||
| FaxNumber: | 4082961018 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/18/2009 | ||||||||
| LastUpdateDate: | 02/18/2009 | ||||||||
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| AuthorizedOfficialLastName: | KAWESCH | ||||||||
| AuthorizedOfficialFirstName: | GARY | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4082961010 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | G066681 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.