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General NPI Number Information
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NPI Number | 1114922127
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Entity Type | Individual
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Provider Name | LAWRENCE A GILL OD
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Gender | Male
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Dates
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Enumeration Date | 06/16/2005
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Last Update Date | 01/08/2016
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Provider Practice Location Address
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Address Line | 3814 BROADWAY
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City | GROVE CITY
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State | OH
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Zip | 43123
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Country | US
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Telephone | 614-871-2080
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Fax | 614-871-1301
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Provider Business Mailing Address
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Address Line | 3814 BROADWAY
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City | GROVE CITY
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State | OH
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Zip | 43123-2234
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Country | US
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Telephone | 614-871-2080
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Fax | 614-871-1301
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2908 T455
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 2908/T455
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 152WS0006X
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Taxonomy Name | Sports Vision Optometrist
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License Number | 2908/T455
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License Number State | OH
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