Provider Demographics
NPI:1164577029
Name:PILLEN, MICHAEL S
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:S
Last Name:PILLEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2610 S DOUGLAS HWY
Mailing Address - Street 2:STE 190
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-6468
Mailing Address - Country:US
Mailing Address - Phone:307-682-7861
Mailing Address - Fax:307-686-8437
Practice Address - Street 1:2610 S DOUGLAS HWY
Practice Address - Street 2:STE 190
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-6468
Practice Address - Country:US
Practice Address - Phone:307-682-7861
Practice Address - Fax:307-686-8437
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician