Provider Demographics
NPI:1902190952
Name:ROBERT F GILLIGAN
Entity Type:Organization
Organization Name:ROBERT F GILLIGAN
Other - Org Name:GILLIGAN'S EYE-LAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:F
Authorized Official - Last Name:GILLIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:601-620-7307
Mailing Address - Street 1:1052 W PATRICK ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-3963
Mailing Address - Country:US
Mailing Address - Phone:301-620-7307
Mailing Address - Fax:301-696-1022
Practice Address - Street 1:1052 W PATRICK ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-3963
Practice Address - Country:US
Practice Address - Phone:301-620-7307
Practice Address - Fax:301-696-1022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1169152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty