Provider Demographics
NPI:1982615720
Name:GILL, DAVID MARTIN (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MARTIN
Last Name:GILL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4030 MORSE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-3018
Mailing Address - Country:US
Mailing Address - Phone:614-473-9700
Mailing Address - Fax:614-473-9703
Practice Address - Street 1:4030 MORSE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-3018
Practice Address - Country:US
Practice Address - Phone:614-473-9700
Practice Address - Fax:614-473-9073
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4697152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0255290Medicaid
OH0255290Medicaid
OHGI4064631Medicare ID - Type UnspecifiedMEDICARE NUMBER