Provider Demographics
NPI:1306917075
Name:GILL, AMARJEET S (OD)
Entity type:Individual
Prefix:DR
First Name:AMARJEET
Middle Name:S
Last Name:GILL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 FISKE HILL RD
Mailing Address - Street 2:
Mailing Address - City:STURBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01566-1231
Mailing Address - Country:US
Mailing Address - Phone:508-347-9844
Mailing Address - Fax:508-347-9844
Practice Address - Street 1:473 MAIN ST
Practice Address - Street 2:
Practice Address - City:FISKDALE
Practice Address - State:MA
Practice Address - Zip Code:01518-1293
Practice Address - Country:US
Practice Address - Phone:508-347-7997
Practice Address - Fax:508-347-7998
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4441152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0702510Medicaid
MAW17570Medicare ID - Type UnspecifiedMEDICARE B