Provider Demographics
NPI:1841233590
Name:GILKISON, RICHARD A (OD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:GILKISON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:16136 SIRUS MINE LN
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-9673
Mailing Address - Country:US
Mailing Address - Phone:909-549-1520
Mailing Address - Fax:
Practice Address - Street 1:660 W VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-2250
Practice Address - Country:US
Practice Address - Phone:909-888-8700
Practice Address - Fax:909-888-8710
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9247T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA132518Medicare PIN