Moushon, Gaylan Wayne

Moushon, Gaylan Wayne is an individual health care provider with primary practice located at 1025 S 6Th St , Springfield IL 62703-2403. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Moushon, Gaylan Wayne can be contacted via phone (217) 528-7541.

Contact Information

Primary practice address
1025 S 6Th St Springfield IL 62703-2403
Phone: (217) 528-7541
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 0460088755 Illinois

Profile Details

NPI number 1548395049
LBN Legal business name Moushon, Gaylan Wayne
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 23rd, 2007
Last updated May 21st, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1548395049 NPPES
Illinois Other K51088 MEDICARE PTAN

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