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General NPI Number Information
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NPI Number | 1811266190
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Entity Type | Organization
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Legal Business Name | LYNN M GILL
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Dates
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Enumeration Date | 12/15/2011
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Last Update Date | 04/12/2012
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Provider Practice Location Address
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Address Line | 5284 HIGHWAY 49 NORTH SUITE 1
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City | MARIPOSA
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State | CA
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Zip | 95338-9501
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Country | US
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Telephone | 209-966-3684
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Fax | 209-966-3601
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Provider Business Mailing Address
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Address Line | 5284 HIGHWAY 49 NORTH SUITE 1
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City | MARIPOSA
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State | CA
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Zip | 95338-9501
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Country | US
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Telephone | 209-966-3684
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Fax | 209-966-3601
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Authorized Official
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Title or Position | OWNER
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Name | MR. LYNN MATTHEW GILL
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Credential | O.D.
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Telephone | 209-966-3684
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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 | 152W00000X
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License Number State | CA
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