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General NPI Number Information
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NPI Number | 1437337193
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Entity Type | Organization
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Legal Business Name | ALAN Y. GILLOGLY O.D.
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Dates
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Enumeration Date | 02/05/2008
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Last Update Date | 12/27/2010
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Provider Practice Location Address
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Address Line | 3014 W BROAD ST
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City | COLUMBUS
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State | OH
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Zip | 43204-2652
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Country | US
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Telephone | 614-274-1451
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Fax | 614-274-2908
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Provider Business Mailing Address
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Address Line | 3014 W BROAD ST
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City | COLUMBUS
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State | OH
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Zip | 43204-2652
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Country | US
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Telephone | 614-274-1451
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Fax | 614-274-2908
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | DR. ALAN Y. GILLOGLY
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Credential | O.D.
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Telephone | 614-274-1451
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 3736 T457
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License Number State | OH
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