Healthcare Provider Details

I. General information

NPI: 1013914225
Provider Name (Legal Business Name): DANA E GILLIN OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 07/28/2014
Certification Date:
Deactivation Date: 03/20/2006
Reactivation Date: 03/27/2006

III. Provider practice location address

112 N EVANS ST SUITE 2
TECUMSEH MI
49286-1578
US

IV. Provider business mailing address

112 N EVANS ST SUITE 2
TECUMSEH MI
49286-1578
US

V. Phone/Fax

Practice location:
  • Phone: 517-424-1010
  • Fax: 517-592-5048
Mailing address:
  • Phone: 517-424-1010
  • Fax: 517-592-5048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901003791
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: