MEDICARE: DR. MONA KAUR 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	14052	CA

General Provider Information

NPI Number	:	1477856003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MONA KAUR GILL O.D.

Provider Business Mailing Address
First Line	:	300 JAMES WAY STE 210
Second Line	:
City	:	PISMO BEACH
State	:	CA
Zip	:	93449-2874
Country	:	US
Telephone Number	:	805-773-6000
Fax Number	:	805-773-2120

Provider Business Practice Location Address
First Line	:	300 JAMES WAY STE 210
Second Line	:
City	:	PISMO BEACH
State	:	CA
Zip	:	93449-2874
Country	:	US
Telephone Number	:	805-773-6000
Fax Number	:	805-773-2120

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

Provider Enumeration Date	:	12/21/2010
Last Update Date	:	09/01/2021

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