MEDICARE: CARA GILLILAND OD, LLC

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
1	152W00000X	Optometrist	S-C80-TA-929	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	511-32592	OTHER	AL	BLUE CROSS

General Provider Information

NPI Number	:	1245612258
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARA GILLILAND OD, LLC

Provider Business Mailing Address
First Line	:	106 EUCLID DR
Second Line	:
City	:	MADISON
State	:	AL
Zip	:	35758-7916
Country	:	US
Telephone Number	:	205-789-5367
Fax Number	:

Provider Business Practice Location Address
First Line	:	6275 UNIVERSITY DR NW
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35806-1776
Country	:	US
Telephone Number	:	256-922-0992
Fax Number	:

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. CARA GILLILAND
Credential	:	O.D.
Telephone Number	:	205-789-5367

Provider Enumeration Date	:	06/25/2015
Last Update Date	:	06/25/2015

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Directions to “CARA GILLILAND OD, LLC ” Practice Location

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