Provider Demographics
NPI:1871714253
Name:GOLCHET, GILA (O D)
Entity type:Individual
Prefix:
First Name:GILA
Middle Name:
Last Name:GOLCHET
Suffix:
Gender:F
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2304
Mailing Address - Country:US
Mailing Address - Phone:310-651-2306
Mailing Address - Fax:310-382-5046
Practice Address - Street 1:2222 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2304
Practice Address - Country:US
Practice Address - Phone:310-651-2306
Practice Address - Fax:310-382-5046
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11137T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11137TOtherLICENSE
CAMG1297325OtherDEA
CAU79239Medicare UPIN