Provider Demographics
NPI:1861427767
Name:GILL, GINA ANN (OD)
Entity type:Individual
Prefix:DR
First Name:GINA
Middle Name:ANN
Last Name:GILL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:ANN
Other - Last Name:STOKES-JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:19576 HOLT ST NW
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-1287
Mailing Address - Country:US
Mailing Address - Phone:763-241-2083
Mailing Address - Fax:
Practice Address - Street 1:19576 HOLT ST NW
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-1287
Practice Address - Country:US
Practice Address - Phone:763-241-2083
Practice Address - Fax:763-241-3801
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2971152W00000X
TX6689T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN410002864Medicare PIN