Provider Demographics
NPI:1285767509
Name:PAUL R GAYEFF OD PC
Entity type:Organization
Organization Name:PAUL R GAYEFF OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:R
Authorized Official - Last Name:GAYEFF
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:906-786-2664
Mailing Address - Street 1:2500 7TH AVE S
Mailing Address - Street 2:SUITE 217
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829-1176
Mailing Address - Country:US
Mailing Address - Phone:906-789-1400
Mailing Address - Fax:
Practice Address - Street 1:2500 7TH AVE S
Practice Address - Street 2:SUITE 217
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-1176
Practice Address - Country:US
Practice Address - Phone:906-789-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002306152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5096229Medicaid
DG1305OtherRAILROAD MEDICARE
MI900B110170OtherBCBS OF MI
DG1305OtherRAILROAD MEDICARE
MI5096229Medicaid