Individual
BRUCE DEVIN GILLILAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
715 CALLAHAN DR, KNOXVILLE, TN 37912-1302
(865) 687-1232
(865) 687-8256
Mailing address
715 CALLAHAN DR, KNOXVILLE, TN 37912-1302
(865) 687-1232
(865) 687-8256
Taxonomy
Speciality
Code
Description
License number
State
152WL0500X
Low Vision Rehabilitation Optometrist
Primary
1593
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010168864
—
VA
05
—
3941143
—
TN
01
—
4102823
BLUE CROSS BLUE SHILED
TN
05
—
77620342
—
KY
01
—
P00317714
RAILROAD MEDICARE
TN
Enumeration date
07/11/2005
Last updated
06/13/2014
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