Provider Demographics
NPI:1578535027
Name:DILL, GERALD L (OD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:L
Last Name:DILL
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 1:1360 E HERNDON AVE STE 401
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3326
Mailing Address - Country:US
Mailing Address - Phone:559-449-5010
Mailing Address - Fax:559-449-5014
Practice Address - Street 1:1360 E HERNDON AVE STE 401
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3326
Practice Address - Country:US
Practice Address - Phone:559-449-5010
Practice Address - Fax:559-449-5014
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7790T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0077900Medicaid
CAGSD004053Medicaid
CAGSD004051Medicaid
CAGSD004050Medicaid
CAGSD004052Medicaid
CAGSD004054Medicaid
CAGSD004054Medicaid
CASD0070902Medicare PIN
CASD0070903Medicare PIN
CAT10721Medicare UPIN
CAGSD004052Medicaid
CAZZZ13883ZMedicare PIN
CAZZZ13844ZMedicare PIN
CASD0077900Medicaid
CAZZZ13845ZMedicare PIN
CASD0070901Medicare PIN
CASD0070900Medicare PIN