Individual
PAUL A GILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
321 E WAYNE ST, FORT WAYNE, IN 46802-2713
(260) 424-5656
(260) 424-4511
Mailing address
4835 LONG CANON PL, FORT WAYNE, IN 46804-6578
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18002653A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000112751
ANTHEM
IN
05
—
200241660A
—
IN
05
—
2904281
—
OH
Enumeration date
08/12/2006
Last updated
01/06/2011
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