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Rafael Antonio Gamba

Optometrist

Eye and Vision Services Providers

112a Riverstone Pkwy, Canton, GA 30114-2448

(770) 874-2020

PECOS Enrollment

This provider is enrolled in PECOS as RAFAEL GAMBA.

Based on the most recent information from CMS, provider Rafael Antonio Gamba is legally eligible to order and refer claims for Part B, HHA and DME services only.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 10 days ago.

Profile Details

Provider ID
1629546437
Provider Type
Individual
Full Name
Gamba, Rafael Antonio
Title
Dr.
Credential
OD

Gender
Male
Sole Proprietor
No
Enumeration Date
11/9/2018
Last Updated
9/21/2021

Contact Information

Practice Location

112a Riverstone Pkwy, Canton, GA 30114-2448

(770) 874-2020

(470) 785-2795

Mailing Location

PO Box 4398, Canton, GA 30114-0017

(770) 874-2020

(470) 785-2795

Provider Taxonomies

Code	Description	License
Code 152W00000X Primary	Description Optometrist Eye and Vision Services Providers	License OPT003130 Georgia

Rafael Antonio Gamba

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

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