Healthcare Provider Details

I. General information

NPI: 1851378459
Provider Name (Legal Business Name): GAIL F STEWART O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 11/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

882 E GREENVILLE AVE
WINCHESTER IN
47394-8441
US

IV. Provider business mailing address

882 E GREENVILLE AVE
WINCHESTER IN
47394-8441
US

V. Phone/Fax

Practice location:
  • Phone: 765-584-1320
  • Fax: 765-584-2317
Mailing address:
  • Phone: 765-584-1320
  • Fax: 765-584-2317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18002205A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: