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Organization
MARK A GILLISPIE O D INC
Active
Organization
MARK A GILLISPIE O D INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK A GILLISPIE O.D. (OWNER / DOCTOR)
(760) 347-6636
Entity
Organization
Contact information
Practice address
52565 HARRISON ST., SUITE 105, COACHELLA, CA 92236
(760) 398-1500
(760) 398-8474
Mailing address
82227 US HIGHWAY 111, SUITE B-2, INDIO, CA 92201-5667
(760) 347-6636
(760) 342-5987
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
8413T
CA
332H00000X
Eyewear Supplier
8413T
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GSD004740
—
CA
Enumeration date
02/27/2008
Last updated
06/12/2009
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