MEDICARE: DR. KENNETH R. GILFILLAN 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	3028	OH

General Provider Information

NPI Number	:	1780678847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH R. GILFILLAN O.D.

Provider Business Mailing Address
First Line	:	8826 CENTER RD
Second Line	:
City	:	WILMINGTON
State	:	OH
Zip	:	45177-8596
Country	:	US
Telephone Number	:	937-725-6696
Fax Number	:	937-848-6101

Provider Business Practice Location Address
First Line	:	3951 W FRANKLIN ST
Second Line	:
City	:	BELLBROOK
State	:	OH
Zip	:	45305-1834
Country	:	US
Telephone Number	:	937-848-6601
Fax Number	:	937-848-6101

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

Provider Enumeration Date	:	09/06/2005
Last Update Date	:	07/08/2007

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