Provider Demographics
NPI:1205278900
Name:GILL, JOHN MATTHEW B (OD)
Entity type:Individual
Prefix:DR
First Name:JOHN MATTHEW
Middle Name:B
Last Name:GILL
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:4266 E RIVER FALLS DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-6649
Mailing Address - Country:US
Mailing Address - Phone:602-625-6017
Mailing Address - Fax:520-888-3645
Practice Address - Street 1:4500 N ORACLE RD STE 423
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-8017
Practice Address - Country:US
Practice Address - Phone:520-888-3616
Practice Address - Fax:520-888-3645
Is Sole Proprietor?:No
Enumeration Date:2013-07-23
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ1920152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist