Provider Demographics
NPI:1720062672
Name:HAYES, GILLIAN J (OD)
Entity type:Individual
Prefix:
First Name:GILLIAN
Middle Name:J
Last Name:HAYES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 NORTH HARRISON STREET
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540
Mailing Address - Country:US
Mailing Address - Phone:609-921-9437
Mailing Address - Fax:609-688-9941
Practice Address - Street 1:419 NORTH HARRISON STREET
Practice Address - Street 2:SUITE 104
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540
Practice Address - Country:US
Practice Address - Phone:609-921-9437
Practice Address - Fax:609-688-9941
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ270A00628200152W00000X
NJ27OM00097500152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
V06674Medicare UPIN