Healthcare Provider Details

I. General information

NPI: 1114039302
Provider Name (Legal Business Name): GILLIAN GEORGE OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2376 GRAND CONCOURSE
BRONX NY
10458-6907
US

IV. Provider business mailing address

406 LYDECKER ST
ENGLEWOOD NJ
07631-1914
US

V. Phone/Fax

Practice location:
  • Phone: 718-365-6300
  • Fax: 718-365-5620
Mailing address:
  • Phone: 201-906-1376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT5016
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number006888
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OA00592600
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4070-35
License Number StateWI
# 5
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG002886
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT.0004101
License Number StateCO
# 7
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3940
License Number StateMN
# 8
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT003056
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: