NPIMap

Individual provider Active NPI

Douglas E Gillies, O.D.

  • Optometrist
  • Monroe, MI
National Provider Identifier
1205831245
Registry record updated Feb 16, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4901002418 Issued in MI
Practice address
1180 N Monroe St
Monroe, MI 48162-3190
Phone
(734) 243-5300
Fax
(734) 243-9956
NPI assigned
Jun 16, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 3071T456 OH
Optometrist 152W00000X 4901002418 MI Primary

Addresses

Primary practice location

1180 N Monroe St
Monroe, MI 48162-3190

Mailing address

1180 N Monroe St
Monroe, MI 48162-3190
Phone (734) 243-5300

Other identifiers 4

IdentifierTypeStateIssuer
0261729MedicaidOH
410049894OtherMIMEDICARE RAILROAD
944352709MedicaidMI
410049893OtherOHMEDICARE RAILROAD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3071OHMDChiropractor
4901002418MIMDOptometrist
3071T456OHMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Eye Institute, LLC. Optometrist Past Accepting new patients
Reed Vision Associates, P.C. Optometrist Past Accepting new patients
Reed Vision Associates, P.C. Optometrist Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1118880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1234742400000",
    "number": "1205831245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1180 N MONROE ST",
            "city": "MONROE",
            "state": "MI",
            "postal_code": "481623190",
            "telephone_number": "734-243-5300",
            "fax_number": "734-243-9956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1180 N MONROE ST",
            "city": "MONROE",
            "state": "MI",
            "postal_code": "481623190",
            "telephone_number": "734-243-5300",
            "fax_number": "734-243-9956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILLIES",
        "first_name": "DOUGLAS",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-16",
        "last_updated": "2009-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OH",
            "license": "3071T456",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901002418",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0261729",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "410049894",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "944352709",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "410049893",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Monroe, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.