Provider Demographics
NPI:1104907690
Name:MATSUOKA, GILBERT M (OD)
Entity type:Individual
Prefix:DR
First Name:GILBERT
Middle Name:M
Last Name:MATSUOKA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2628 PLEASANT HILL RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-2034
Mailing Address - Country:US
Mailing Address - Phone:925-947-6696
Mailing Address - Fax:925-947-6761
Practice Address - Street 1:2628 PLEASANT HILL RD
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-2034
Practice Address - Country:US
Practice Address - Phone:925-947-6696
Practice Address - Fax:925-947-6761
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6741 T152W00000X
CA006741T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0067411Medicare UPIN
CA1231760001Medicare NSC