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Organization

DUANE A GILLAM

Active
Other names
Lafayette Vision Care
Organization subpart
No

Provider details

NPI number
Authorized official
DUANE A GILLAM OD (OWNER)
(765) 448-2711
Entity
Organization

Contact information

Practice address
638 S EARL AVE, LAFAYETTE, IN 47904-3264
(765) 448-2711
(765) 448-2995
Mailing address
638 S EARL AVE, LAFAYETTE, IN 47904-3264
(765) 448-2711
(765) 448-2995

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18001683B
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100230920
IN
Enumeration date
02/06/2009
Last updated
05/24/2016
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