Provider Demographics
NPI:1255399770
Name:GASKINS, PHILIP DILLON (OD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:DILLON
Last Name:GASKINS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:1960 RANDOLPH RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1129
Practice Address - Country:US
Practice Address - Phone:704-372-5332
Practice Address - Fax:704-714-5343
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1292152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909313Medicaid
NC246624CMedicare ID - Type UnspecifiedMEDICARE
NC8909313Medicaid