GM Revelle Inc

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

GM REVELLE INC

Practice address

2820 Plainfield Rd
Joliet, IL 60435-1167

Phone

(815) 436-1144

Fax

(815) 436-1260

NPI assigned

Aug 31, 2005

Organization subpart

No

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

Authorized official

Name

Dr. Dennis E Dettmann, O.D.

Title

Owner

Phone

(815) 436-1144

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Vision Gallery Doing business as

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

{
    "created_epoch": "1125446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209513600000",
    "number": "1972597342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2820 PLAINFIELD RD",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604351167",
            "telephone_number": "815-436-1144",
            "fax_number": "815-436-1260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2820 PLAINFIELD RD",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604351167",
            "telephone_number": "815-436-1144",
            "fax_number": "815-436-1260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GM REVELLE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-31",
        "last_updated": "2008-04-30",
        "status": "A",
        "authorized_official_last_name": "DETTMANN",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "815-436-1144",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "046007054",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "9932299",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vision Gallery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Laura Gillespie
• David J Gilmore, P.A.-C
• Visvanatha V Giri, M.D.
• Xheni Gjergo
• Sarah Ann Glawe
• Mary Elizabeth Gniady, APRN, NP-C, CCNS
• Dena Gocal McGrath
• Nathan T Goff, DPT
• Goldielocks Zone, Inc.
• Miroslaba Gomez, MD

• All providers in Joliet, IL
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2008; 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.