Provider Demographics
NPI:1184257347
Name:JOHN MATTHEW GILL, OD AND ASSOCIATES
Entity type:Organization
Organization Name:JOHN MATTHEW GILL, OD AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMESTRIST/PRACTICE OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN MATTHEW
Authorized Official - Middle Name:B
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:602-625-5017
Mailing Address - Street 1:4266 E RIVER FALLS DRIVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712
Mailing Address - Country:US
Mailing Address - Phone:602-625-6017
Mailing Address - Fax:
Practice Address - Street 1:4500 N. ORACLE ROAD, SUITE 423
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705
Practice Address - Country:US
Practice Address - Phone:520-888-3624
Practice Address - Fax:520-888-2210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-17
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty