Healthcare Provider Details

I. General information

NPI: 1841293040
Provider Name (Legal Business Name): JENNIFER R GILES O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31519 WINTERPLACE PKWY STE 1
SALISBURY MD
21804-1884
US

IV. Provider business mailing address

31519 WINTERPLACE PKWY STE 1
SALISBURY MD
21804-1884
US

V. Phone/Fax

Practice location:
  • Phone: 410-546-2500
  • Fax: 410-546-5005
Mailing address:
  • Phone: 410-546-2500
  • Fax: 410-546-5005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTA1600
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: