Provider Demographics
NPI:1831349521
Name:GILLOW, CHRISTINA MARIE (OD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:MARIE
Last Name:GILLOW
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 1:314 HONESDALE RD
Mailing Address - Street 2:PO BOX 310
Mailing Address - City:WAYMART
Mailing Address - State:PA
Mailing Address - Zip Code:18472-9338
Mailing Address - Country:US
Mailing Address - Phone:570-488-6710
Mailing Address - Fax:570-571-6050
Practice Address - Street 1:314 HONESDALE RD
Practice Address - Street 2:
Practice Address - City:WAYMART
Practice Address - State:PA
Practice Address - Zip Code:18472-9338
Practice Address - Country:US
Practice Address - Phone:570-488-6710
Practice Address - Fax:570-571-6050
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002110152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1025943650001Medicaid
PAP00943091OtherRAILROAD MEDICARE
PA168399Medicare UPIN
PA25126Medicare PIN
PAP00943091OtherRAILROAD MEDICARE