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General NPI Number Information
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NPI Number | 1780678847
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Entity Type | Individual
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Provider Name | KENNETH R. GILFILLAN O.D.
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Gender | Male
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Dates
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Enumeration Date | 09/06/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3951 W FRANKLIN ST
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City | BELLBROOK
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State | OH
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Zip | 45305-1834
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Country | US
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Telephone | 937-848-6601
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Fax | 937-848-6101
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Provider Business Mailing Address
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Address Line | 8826 CENTER RD
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City | WILMINGTON
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State | OH
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Zip | 45177-8596
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Country | US
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Telephone | 937-725-6696
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Fax | 937-848-6101
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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 | 3028
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License Number State | OH
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