| Doctor Name: | PHILLIP RANDALL GILLETTE |
| NPI Number: | 1629170360 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 1088 Industrial Pkwy Saraland, AL - 365713720 |
| Business Phone Number: | 2516753666 |
| Business Fax Number: | 2516759366 |
| Mailing Address: | 1088 Industrial Pkwy, SARALAND |
| State: | AL |
| Postal Code: | 365713720 |
| Phone Number: | 2516753666 |
| Fax Number: | 2516759366 |
| NPI Enumeration Date: | 09/02/2006 |
| NPI Last Update Date: | 02/08/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 156FX1800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Technician/Technologist |
| Taxonomy Specialization: | Optician |
| Taxonomy Definition: | |