Provider Demographics
NPI:1285657742
Name:GILL, BRIAN KEITH (OD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:KEITH
Last Name:GILL
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 1:2398 5TH AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:BELLE FOURCHE
Mailing Address - State:SD
Mailing Address - Zip Code:57717-2340
Mailing Address - Country:US
Mailing Address - Phone:605-723-3937
Mailing Address - Fax:605-723-3940
Practice Address - Street 1:2398 5TH AVE STE 105
Practice Address - Street 2:
Practice Address - City:BELLE FOURCHE
Practice Address - State:SD
Practice Address - Zip Code:57717-2340
Practice Address - Country:US
Practice Address - Phone:605-723-3937
Practice Address - Fax:605-723-3940
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD624152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4992551OtherWELLMARK - DEADWOOD
SD9203662Medicaid
SD4993782OtherWELLMARK - SPEARFISH
SD9203660Medicaid
SDS101185Medicare PIN
SD4992551OtherWELLMARK - DEADWOOD
SD9203662Medicaid