Provider Demographics
NPI:1518184720
Name:GILBERT JAMES OD INC
Entity Type:Organization
Organization Name:GILBERT JAMES OD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:770-773-1584
Mailing Address - Street 1:800 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-1406
Mailing Address - Country:US
Mailing Address - Phone:706-692-7510
Mailing Address - Fax:706-692-7512
Practice Address - Street 1:800 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-1406
Practice Address - Country:US
Practice Address - Phone:706-692-7510
Practice Address - Fax:706-692-7512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1178152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U06516Medicare UPIN