Provider Demographics
NPI:1588659106
Name:GILLEY, BARBARA KAY (OD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:KAY
Last Name:GILLEY
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 1:1717 W JESSE JAMES RD
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64024-1801
Mailing Address - Country:US
Mailing Address - Phone:816-630-1905
Mailing Address - Fax:816-637-2034
Practice Address - Street 1:1717 W JESSE JAMES RD
Practice Address - Street 2:
Practice Address - City:EXCELSIOR SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64024-1801
Practice Address - Country:US
Practice Address - Phone:816-630-1905
Practice Address - Fax:816-637-2034
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOTO2562152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO312133010Medicaid
MOMA3770Medicare UPIN