Provider Demographics
NPI:1063823912
Name:GILLIN EYE CARE PC
Entity Type:Organization
Organization Name:GILLIN EYE CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:GILLIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:517-424-1010
Mailing Address - Street 1:112 N EVANS ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:TECUMSEH
Mailing Address - State:MI
Mailing Address - Zip Code:49286-1578
Mailing Address - Country:US
Mailing Address - Phone:517-424-1010
Mailing Address - Fax:
Practice Address - Street 1:112 N EVANS ST
Practice Address - Street 2:SUITE 2
Practice Address - City:TECUMSEH
Practice Address - State:MI
Practice Address - Zip Code:49286-1578
Practice Address - Country:US
Practice Address - Phone:517-424-1010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003791152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty