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NPI Code Detail

MEDICARE: DR. HEATH BRADLEY GILBERT O.D.

MEDICARE: DR. HEATH BRADLEY GILBERT O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist4353T259OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1310928411031OTHEROHCARE SOURCE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3310928411030OTHEROHCARE SOURCE

General Provider Information

NPI Number : 1114923844
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. HEATH BRADLEY GILBERT O.D.
Provider Business Mailing Address
First Line : 813 TROY ST
Second Line :
City : DAYTON
State : OH
Zip : 45404-1852
Country : US
Telephone Number : 937-228-2020
Fax Number : 937-228-8769
Provider Business Practice Location Address
First Line : 813 TROY ST
Second Line :
City : DAYTON
State : OH
Zip : 45404-1852
Country : US
Telephone Number : 937-228-2020
Fax Number : 937-228-8769
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2005
Last Update Date : 01/18/2008

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