Provider Demographics
NPI:1033101944
Name:GILLES, JOHN ARTHUR (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ARTHUR
Last Name:GILLES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8688 RUFFIAN LN
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-3411
Mailing Address - Country:US
Mailing Address - Phone:812-853-8191
Mailing Address - Fax:812-858-1470
Practice Address - Street 1:8688 RUFFIAN LN
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-3411
Practice Address - Country:US
Practice Address - Phone:812-853-8191
Practice Address - Fax:812-858-1470
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-17
Last Update Date:2007-07-08
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-04-12
Provider Licenses
StateLicense IDTaxonomies
IN18002239B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0160680001OtherMEDICARE ID FOR EYEGLASSE
IN000000089373OtherANTHEM BCBS
INGI161240OtherCLARITY VISION
IN000000089373OtherANTHEM BCBS
IN0160680001OtherMEDICARE ID FOR EYEGLASSE