MEDICARE: DR. BRIAN KEITH GILL 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
1	152W00000X	Optometrist	624	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4992551	OTHER	SD	WELLMARK - DEADWOOD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	4993782	OTHER	SD	WELLMARK - SPEARFISH
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285657742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN KEITH GILL O.D.

Provider Business Mailing Address
First Line	:	2398 5TH AVE STE 105
Second Line	:
City	:	BELLE FOURCHE
State	:	SD
Zip	:	57717-2340
Country	:	US
Telephone Number	:	605-723-3937
Fax Number	:	605-723-3940

Provider Business Practice Location Address
First Line	:	2398 5TH AVE STE 105
Second Line	:
City	:	BELLE FOURCHE
State	:	SD
Zip	:	57717-2340
Country	:	US
Telephone Number	:	605-723-3937
Fax Number	:	605-723-3940

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	03/25/2024

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