Individual
JUSTIN CASE GILLETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
112 GLOVER DR, MOUNT ORAB, OH 45154-8390
(937) 444-2525
Mailing address
PO BOX 207170, DALLAS, TX 75320-7156
(636) 200-4393
(636) 527-0766
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
2156DT
KY
152W00000X
Optometrist
Primary
OPT007009
OH
Other
Enumeration date
03/30/2019
Last updated
10/21/2021
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