Provider Demographics
NPI:1407631898
Name:STIERMAN, GILLIAN DALE (OD)
Entity Type:Individual
Prefix:
First Name:GILLIAN
Middle Name:DALE
Last Name:STIERMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 E HIGHLAND AVE STE B240
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4741
Mailing Address - Country:US
Mailing Address - Phone:480-994-5012
Mailing Address - Fax:480-990-7364
Practice Address - Street 1:5620 W THUNDERBIRD RD STE B1
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4638
Practice Address - Country:US
Practice Address - Phone:602-547-2002
Practice Address - Fax:602-942-2667
Is Sole Proprietor?:No
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOPT002740152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist