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Contact Information

MARK A GILLISPIE O D INC
52565 HARRISON ST.
SUITE 105
COACHELLA, CA92236
 Phone: 760-398-1500
 Fax: 760-398-8474
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Optometrist

152W00000X 41 Optometry
 

Eyewear Supplier

332H00000X 87 All Other Suppliers
Indicates primary specialty

NPI Profile & details for MARK A GILLISPIE O D INC · (Female)

NPI Number 1467621185
Status Active
Credentials
Entity Individual
Enumeration date 02/27/2008
Last updated 06/12/2009 - About 17 years ago
Sole proprietor 1 Not specified
Identifiers
  • CA License # 8413T
  • CA Medicaid GSD004740
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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