Provider Demographics
NPI:1437337193
Name:ALAN Y. GILLOGLY O.D.
Entity Type:Organization
Organization Name:ALAN Y. GILLOGLY O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:Y
Authorized Official - Last Name:GILLOGLY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:614-274-1451
Mailing Address - Street 1:3014 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43204-2652
Mailing Address - Country:US
Mailing Address - Phone:614-274-1451
Mailing Address - Fax:614-274-2908
Practice Address - Street 1:3014 W BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43204-2652
Practice Address - Country:US
Practice Address - Phone:614-274-1451
Practice Address - Fax:614-274-2908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3736 T457332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0189160001Medicare NSC