NPIMap

Organization Active NPI

Duane a Gillam

  • Optometrist
  • Lafayette, IN
National Provider Identifier
1902045446
Registry record updated May 24, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
18001683B Issued in IN
Legal business name
DUANE A GILLAM
Practice address
638 S Earl Ave
Lafayette, IN 47904-3264
Phone
(765) 448-2711
Fax
(765) 448-2995
NPI assigned
Feb 6, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 24, 2016

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

Authorized official

Name
Duane A Gillam, OD
Title
Owner
Phone
(765) 448-2711

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 18001683B IN Primary

Addresses

Primary practice location

638 S Earl Ave
Lafayette, IN 47904-3264

Mailing address

638 S Earl Ave
Lafayette, IN 47904-3264
Phone (765) 448-2711

Other identifiers 1

IdentifierTypeStateIssuer
100230920MedicaidIN

Other names 1

  • Lafayette Vision Care Doing business as

National Provider Directory

National Provider Directory

Locations

3711 Rome Dr
Ste B
Lafayette, IN 47905
Phone (765) 448-2711

Practitioners & affiliated clinicians

Practitioners 30

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1233878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464048000000",
    "number": "1902045446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "638 S EARL AVE",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479043264",
            "telephone_number": "765-448-2711",
            "fax_number": "765-448-2995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "638 S EARL AVE",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479043264",
            "telephone_number": "765-448-2711",
            "fax_number": "765-448-2995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DUANE A GILLAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-06",
        "last_updated": "2016-05-24",
        "status": "A",
        "authorized_official_last_name": "GILLAM",
        "authorized_official_first_name": "DUANE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "765-448-2711",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18001683B",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100230920",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lafayette Vision Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lafayette, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2016; 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.