Provider Demographics
NPI:1821232893
Name:GILLIAN T. GEORGE, OD
Entity Type:Organization
Organization Name:GILLIAN T. GEORGE, OD
Other - Org Name:ENGLEWOOD VISION CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GILLIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-569-2442
Mailing Address - Street 1:200 ENGLE ST
Mailing Address - Street 2:SUITE 12
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2440
Mailing Address - Country:US
Mailing Address - Phone:201-569-2442
Mailing Address - Fax:201-569-2552
Practice Address - Street 1:200 ENGLE ST
Practice Address - Street 2:SUITE 12
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2440
Practice Address - Country:US
Practice Address - Phone:201-569-2442
Practice Address - Fax:201-569-2552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-22
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00592600152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
154002Medicare PIN