Provider Demographics
NPI:1396733648
Name:GILL, SUKHDEV (OD)
Entity type:Individual
Prefix:
First Name:SUKHDEV
Middle Name:
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 1:11608 NE 61ST CT
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-4780
Mailing Address - Country:US
Mailing Address - Phone:425-223-3222
Mailing Address - Fax:
Practice Address - Street 1:13112 120TH AVE NE
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034
Practice Address - Country:US
Practice Address - Phone:425-223-3222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004274152W00000X
WAOD00004113152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4652607Medicaid
WAOD0019Medicaid
MI4652581Medicaid
MI4652590Medicaid
MI4652581Medicaid
MI4652607Medicaid