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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

NPI # 1467621185
LBN Legal business name MARK A GILLISPIE O D INC
Authorized official MARK GILLISPIE - (OWNER / DOCTOR)
Entity Organization
Organization subpart 1 No
Enumeration date 02/27/2008
Last updated 06/12/2009 - About 17 years ago
Identifiers
CA License # 8413T
CA Medicaid GSD004740
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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