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1023853173 NPI number — HARPER BREANN GILLENTINE OD

NPI Number: 1023853173
Health Care Provider/Practitioner: HARPER BREANN GILLENTINE OD

Information about “1023853173” NPI (HARPER BREANN GILLENTINE OD) exists in 1023853173 in HTML format HTML  |  1023853173 in plain Text format TXT  |  1023853173 in PDF (Portable Document Format) PDF  |  1023853173 in an XML format XML  formats.

NPI Number : 1023853173 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1023853173",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GILLENTINE",
    "FirstName": "HARPER",
    "MiddleName": "BREANN",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "OD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "63 S ROCKFORD DR STE 220",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "TEMPE",
    "MailingAddressStateName": "AZ",
    "MailingAddressPostalCode": "85288-6226",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "602-598-7491",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1626 N LITCHFIELD RD STE 110",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GOODYEAR",
    "PracticeLocationAddressStateName": "AZ",
    "PracticeLocationAddressPostalCode": "85395-1399",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "713-797-1010",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/29/2024",
    "LastUpdateDate": "08/07/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "152W00000X",
          "TaxonomyName": "Optometrist",
          "LicenseNumber": "11111TG",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "152W00000X",
          "TaxonomyName": "Optometrist",
          "LicenseNumber": "OPT-002866",
          "LicenseNumberStateCode": "AZ",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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