Individual
JILL GAVIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OPTICIAN
Contact information
Practice address
1200 MARKETPLACE DR, ROCHESTER, NY 14623-6002
(585) 292-6020
Mailing address
1200 MARKETPLACE DR, ROCHESTER, NY 14623-6002
(585) 292-6020
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0006621-2
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1205949534
—
NY
05
—
1679859201
—
NY
Enumeration date
12/11/2018
Last updated
12/11/2018
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