Provider Demographics
NPI:1114923844
Name:GILBERT, HEATH BRADLEY (OD)
Entity Type:Individual
Prefix:DR
First Name:HEATH
Middle Name:BRADLEY
Last Name:GILBERT
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 1:813 TROY ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45404-1852
Mailing Address - Country:US
Mailing Address - Phone:937-228-2020
Mailing Address - Fax:937-228-8769
Practice Address - Street 1:813 TROY ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45404-1852
Practice Address - Country:US
Practice Address - Phone:937-228-2020
Practice Address - Fax:937-228-8769
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4353T259152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH310928411031OtherCARE SOURCE
OH0886242Medicaid
OH310928411030OtherCARE SOURCE
OH0722041Medicare PIN
OH310928411031OtherCARE SOURCE
OH0722042Medicare PIN