Provider Demographics
NPI:1689735003
Name:DOELL, GAIL B (OD)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:B
Last Name:DOELL
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 1:7954 BIG BEND BLVD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER GROVES
Mailing Address - State:MO
Mailing Address - Zip Code:63119-2711
Mailing Address - Country:US
Mailing Address - Phone:314-962-7580
Mailing Address - Fax:314-962-3026
Practice Address - Street 1:7954 BIG BEND BLVD
Practice Address - Street 2:
Practice Address - City:WEBSTER GROVES
Practice Address - State:MO
Practice Address - Zip Code:63119-2711
Practice Address - Country:US
Practice Address - Phone:314-962-7580
Practice Address - Fax:314-962-3026
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02653152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOT42561Medicare UPIN