Provider Demographics
NPI:1124642871
Name:BILODEAU, JEAN-GUY
Entity type:Individual
Prefix:DR
First Name:JEAN-GUY
Middle Name:
Last Name:BILODEAU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4084 E CATCLAW ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-9542
Mailing Address - Country:US
Mailing Address - Phone:954-614-2092
Mailing Address - Fax:
Practice Address - Street 1:183 W APACHE TRL STE 101
Practice Address - Street 2:
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85120-3426
Practice Address - Country:US
Practice Address - Phone:480-824-7360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-28
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOPT-002595152W00000X
FL5801152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist