MEDICARE: DR. JONELL D 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	OPC3708	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1518952035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONELL D GILL OD

Provider Business Mailing Address
First Line	:	1247 LAKELAND HILLS BLVD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33805-4673
Country	:	US
Telephone Number	:	863-688-5604
Fax Number	:	813-662-3937

Provider Business Practice Location Address
First Line	:	1247 LAKELAND HILLS BLVD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33805-4673
Country	:	US
Telephone Number	:	863-688-5604
Fax Number	:	813-662-3937

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

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	07/08/2020

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