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NPI Code Detail

MEDICARE: DR. DOUGLAS E GILLIES O.D.

MEDICARE: DR. DOUGLAS E GILLIES O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist3071T456OH
2152W00000XOptometrist4901002418MI

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2410049894OTHERMIMEDICARE RAILROAD
4410049893OTHEROHMEDICARE RAILROAD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1205831245
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DOUGLAS E GILLIES O.D.
Provider Business Mailing Address
First Line : 1180 N MONROE ST
Second Line :
City : MONROE
State : MI
Zip : 48162-3190
Country : US
Telephone Number : 734-243-5300
Fax Number : 734-243-9956
Provider Business Practice Location Address
First Line : 1180 N MONROE ST
Second Line :
City : MONROE
State : MI
Zip : 48162-3190
Country : US
Telephone Number : 734-243-5300
Fax Number : 734-243-9956
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2005
Last Update Date : 02/16/2009

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Directions to “ DR. DOUGLAS E GILLIES O.D.” Practice Location

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