Provider Demographics
NPI:1184801649
Name:DANA E GILLIN OD PC
Entity type:Organization
Organization Name:DANA E GILLIN OD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:E
Authorized Official - Last Name:GILLIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD PC
Authorized Official - Phone:517-423-2001
Mailing Address - Street 1:904 W CHICAGO BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:TECUMSEH
Mailing Address - State:MI
Mailing Address - Zip Code:49286-1213
Mailing Address - Country:US
Mailing Address - Phone:517-423-2001
Mailing Address - Fax:517-423-7030
Practice Address - Street 1:904 W CHICAGO BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:TECUMSEH
Practice Address - State:MI
Practice Address - Zip Code:49286-1213
Practice Address - Country:US
Practice Address - Phone:517-423-2001
Practice Address - Fax:517-423-7030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003791152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU50619Medicare UPIN
MI5735000001Medicare NSC
MI0P21380Medicare PIN