MEDICARE: DR. MARC RANDOLPH GILBERT 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	3858T056	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	310928411026	OTHER	OH	CARE SOURCE
2	310928411027	OTHER	OH	CARE SOURCE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659377190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARC RANDOLPH GILBERT O.D.

Provider Business Mailing Address
First Line	:	813 TROY ST
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45404-1852
Country	:	US
Telephone Number	:	937-228-2020
Fax Number	:	937-228-8769

Provider Business Practice Location Address
First Line	:	813 TROY ST
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45404-1852
Country	:	US
Telephone Number	:	937-228-2020
Fax Number	:	937-228-8769

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

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	01/18/2008

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