MEDICARE: MONA GILL O D CORP

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
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1891365003
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONA GILL O D CORP

Provider Business Mailing Address
First Line	:	300 JAMES WAY STE 210
Second Line	:
City	:	PISMO BEACH
State	:	CA
Zip	:	93449-2874
Country	:	US
Telephone Number	:	805-773-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 JAMES WAY STE 210
Second Line	:
City	:	PISMO BEACH
State	:	CA
Zip	:	93449-2874
Country	:	US
Telephone Number	:	805-773-6000
Fax Number	:	805-773-2120

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MONA KAUR GILL
Credential	:	OD
Telephone Number	:	661-205-7287

Provider Enumeration Date	:	06/29/2021
Last Update Date	:	09/03/2021

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Directions to “MONA GILL O D CORP ” Practice Location

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