Healthcare Provider Details

I. General information

NPI: 1063823912
Provider Name (Legal Business Name): GILLIN EYE CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2014
Last Update Date: 05/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

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:
Mailing address:
  • Phone: 517-424-1010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. DANA EDWARD GILLIN
Title or Position: OWNER
Credential: O.D.
Phone: 517-424-1010