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NPI Code Detail

MEDICARE: DR. GEORGE GEORGILIS O.D.

MEDICARE:  DR. GEORGE  GEORGILIS  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
1152W00000XOptometrist0915DTKY
2152W00000XOptometristOPT.007097OH

Other Identifiers

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

General Provider Information

NPI Number : 1609801463
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GEORGE GEORGILIS O.D.
Provider Business Mailing Address
First Line : PO BOX 207170
Second Line :
City : DALLAS
State : TX
Zip : 75320-7170
Country : US
Telephone Number : 636-200-4393
Fax Number : 636-527-0766
Provider Business Practice Location Address
First Line : 8118 MONTGOMERY RD
Second Line :
City : CINCINNATI
State : OH
Zip : 45236-2935
Country : US
Telephone Number : 513-891-9030
Fax Number : 513-891-8049
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2006
Last Update Date : 09/09/2022

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Directions to “ DR. GEORGE GEORGILIS O.D.” Practice Location

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