Provider Demographics
NPI:1962026419
Name:GILL, JOSHPAL SINGH (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSHPAL
Middle Name:SINGH
Last Name:GILL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5375 PLOVER CT
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:WA
Mailing Address - Zip Code:98230-6321
Mailing Address - Country:US
Mailing Address - Phone:209-834-4972
Mailing Address - Fax:
Practice Address - Street 1:1815 MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:WA
Practice Address - Zip Code:98248-9454
Practice Address - Country:US
Practice Address - Phone:360-746-8890
Practice Address - Fax:360-393-4004
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-01
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD61064032152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1278350Medicaid
WAOD61064032OtherACTIVE STATE LICENSE NUMBER