Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 12602 | KS |
NPI | 1003840935 |
---|---|
Provider Name | Dr. Jane M Gillogly |
First Address | Overland Park, KS 66210 |
Second Address | Overland Park, KS 66210 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U39168 | (02) |