Provider Demographics
NPI:1285760629
Name:O'CONNOR, GREGORY MICHAEL (OD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:MICHAEL
Last Name:O'CONNOR
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:GREGORY
Other - Middle Name:MICHAEL
Other - Last Name:O'CONNOR
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:3840 CROSS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-4933
Mailing Address - Country:US
Mailing Address - Phone:310-456-7464
Mailing Address - Fax:310-456-0430
Practice Address - Street 1:3840 CROSS CREEK RD
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-4933
Practice Address - Country:US
Practice Address - Phone:310-456-7464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6766152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist