Healthcare Provider Details

I. General information

NPI: 1689697724
Provider Name (Legal Business Name): NAVDEEP GILL OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5620 W THUNDERBIRD RD STE B1
GLENDALE AZ
85306-4638
US

IV. Provider business mailing address

2111 E HIGHLAND AVE STE 240
PHOENIX AZ
85016-4794
US

V. Phone/Fax

Practice location:
  • Phone: 480-994-5012
  • Fax: 480-994-9479
Mailing address:
  • Phone: 480-994-5012
  • Fax: 602-942-2667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4533
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1663
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: