Healthcare Provider Details

I. General information

NPI: 1124642871
Provider Name (Legal Business Name): DR. JEAN-GUY BILODEAU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2020
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

183 W APACHE TRL STE 101
APACHE JUNCTION AZ
85120-3426
US

IV. Provider business mailing address

4084 E CATCLAW ST
GILBERT AZ
85296-9542
US

V. Phone/Fax

Practice location:
  • Phone: 480-824-7360
  • Fax:
Mailing address:
  • Phone: 954-614-2092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT-002595
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5801
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: