MEDICARE: KIRAN GILL OD

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	976	NV

General Provider Information

NPI Number	:	1386138121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRAN GILL OD

Provider Business Mailing Address
First Line	:	9221 SIERRA COLLEGE BLVD STE 130
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95661-5934
Country	:	US
Telephone Number	:	916-797-6747
Fax Number	:

Provider Business Practice Location Address
First Line	:	9221 SIERRA COLLEGE BLVD STE 130
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95661-5934
Country	:	US
Telephone Number	:	916-797-6747
Fax Number	:	916-797-6728

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

Provider Enumeration Date	:	06/15/2018
Last Update Date	:	11/01/2024

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