1033101944 NPI number — DR. JOHN ARTHUR GILLES O.D.

Table of content: DR. JOHN ARTHUR GILLES O.D. (NPI 1033101944)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033101944 NPI number — DR. JOHN ARTHUR GILLES O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GILLES
Provider First Name:
JOHN
Provider Middle Name:
ARTHUR
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033101944
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/23/2006
NPI Reactivation Date:
04/12/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8688 RUFFIAN LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWBURGH
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47630-3411
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-853-8191
Provider Business Mailing Address Fax Number:
812-858-1470

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8688 RUFFIAN LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWBURGH
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47630-3411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-853-8191
Provider Business Practice Location Address Fax Number:
812-858-1470
Provider Enumeration Date:
08/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  18002239B , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0160680001 . This is a "MEDICARE ID FOR EYEGLASSE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000089373 . This is a "ANTHEM BCBS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: GI161240 . This is a "CLARITY VISION" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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