Provider Demographics
NPI:1891982948
Name:TANYA N GILL OPTOMETRIC, INC.
Entity Type:Organization
Organization Name:TANYA N GILL OPTOMETRIC, INC.
Other - Org Name:OAKLAND VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:NATASHIA
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:510-893-5566
Mailing Address - Street 1:1960 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-2206
Mailing Address - Country:US
Mailing Address - Phone:510-893-5566
Mailing Address - Fax:510-893-3921
Practice Address - Street 1:1960 BROADWAY
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-2206
Practice Address - Country:US
Practice Address - Phone:510-893-5566
Practice Address - Fax:510-893-3921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11136T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11136TOtherOPTOMETRY LICENSE
CA11136TOtherOPTOMETRY LICENSE
SD0111360Medicare PIN