Provider Demographics
NPI:1700801420
Name:MATHESON, JILL GEERING (OD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:GEERING
Last Name:MATHESON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 GLACIER AVE
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-1855
Mailing Address - Country:US
Mailing Address - Phone:907-586-9864
Mailing Address - Fax:907-463-2679
Practice Address - Street 1:800 GLACIER AVE
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-1845
Practice Address - Country:US
Practice Address - Phone:907-586-9864
Practice Address - Fax:907-463-2679
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA148152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKOD1481Medicaid
AKU36418Medicare UPIN
AKK152123Medicare ID - Type Unspecified