Provider Demographics
NPI:1811203847
Name:GANCH, JILL (OD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:
Last Name:GANCH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:BARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2000 MEMORIAL DR
Mailing Address - Street 2:SUITE 6
Mailing Address - City:ST JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819-8321
Mailing Address - Country:US
Mailing Address - Phone:802-748-3536
Mailing Address - Fax:802-748-4838
Practice Address - Street 1:2000 MEMORIAL DR
Practice Address - Street 2:SUITE 6
Practice Address - City:ST JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-8321
Practice Address - Country:US
Practice Address - Phone:802-748-3536
Practice Address - Fax:802-748-4838
Is Sole Proprietor?:No
Enumeration Date:2010-08-27
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT030.0068208152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist