Organization Name: | MARK A GILLISPIE O D INC |
NPI Number: | 1467621185 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MARK A GILLISPIE (OWNER / DOCTOR) |
Mailing Address: | 52565 Harrison St. Suite 105 Coachella |
State: | CA US |
Postal Code: | 92236 |
Phone Number: | 7603981500 |
Fax Number: | 7603988474 |
NPI Enumeration Date: | 02/27/2008 |
NPI Last Update Date: | 06/12/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332H00000X |
License Number: | 8413T |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | CA |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Eyewear Supplier (Equipment, not the service) |
Taxonomy Specialization: | |
Taxonomy Definition: | An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist. |