Provider Demographics
NPI:1740388990
Name:GILDERSLEEVE, PHILIP LYLE (OD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:LYLE
Last Name:GILDERSLEEVE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:612 N 4TH ST
Mailing Address - Street 2:POB 818
Mailing Address - City:ONEILL
Mailing Address - State:NE
Mailing Address - Zip Code:68763-1326
Mailing Address - Country:US
Mailing Address - Phone:402-336-2220
Mailing Address - Fax:402-336-4845
Practice Address - Street 1:612 N 4TH ST
Practice Address - Street 2:POB 818
Practice Address - City:ONEILL
Practice Address - State:NE
Practice Address - Zip Code:68763-1326
Practice Address - Country:US
Practice Address - Phone:402-336-2220
Practice Address - Fax:402-336-4845
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE856152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEP00410801OtherRR MEDICARE
NEP00410801OtherRR MEDICARE