Provider Demographics
NPI:1588990329
Name:GBM ASSOCIATES INC
Entity type:Organization
Organization Name:GBM ASSOCIATES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:815-436-8605
Mailing Address - Street 1:1960 ESSINGTON RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-1616
Mailing Address - Country:US
Mailing Address - Phone:815-436-8605
Mailing Address - Fax:815-439-2157
Practice Address - Street 1:1960 ESSINGTON RD
Practice Address - Street 2:SUITE 102
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-1616
Practice Address - Country:US
Practice Address - Phone:815-436-8605
Practice Address - Fax:815-439-2157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-29
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046006736152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL2869Medicare PIN