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General NPI Number Information
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NPI Number | 1790772200
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Entity Type | Individual
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Provider Name | MARILYN K. GILBREATH O.D.
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Gender | Female
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Dates
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Enumeration Date | 09/29/2005
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Last Update Date | 07/02/2009
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Provider Practice Location Address
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Address Line | 102 SCOTT ST
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City | UKIAH
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State | CA
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Zip | 95482-4316
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Country | US
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Telephone | 707-462-7040
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Fax | 707-462-7089
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Provider Business Mailing Address
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Address Line | 102 SCOTT ST
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City | UKIAH
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State | CA
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Zip | 95482-4316
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Country | US
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Telephone | 707-462-7040
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Fax | 707-462-7089
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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 | OPT7472T
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License Number State | CA
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