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General NPI Number Information
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NPI Number | 1922098540
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Entity Type | Individual
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Provider Name | ALAN YOUNG GILLOGLY O.D.
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Gender | Male
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Dates
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Enumeration Date | 10/25/2005
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Last Update Date | 09/18/2012
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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 |
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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 | 3736 T457
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License Number State | OH
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