Mark a Gillispie O D Inc

Primary specialty

OptometristTaxonomy code 152W00000X

License

8413T Issued in CA

Legal business name

MARK A GILLISPIE O D INC

Practice address

52565 Harrison St.
Suite 105
Coachella, CA 92236

Phone

(760) 398-1500

Fax

(760) 398-8474

NPI assigned

Feb 27, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mark A Gillispie, O.D.

Title

Owner / Doctor

Phone

(760) 347-6636

Specialties & licenses 2

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1204070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1244764800000",
    "number": "1467621185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "82227 US HIGHWAY 111",
            "address_2": "SUITE B-2",
            "city": "INDIO",
            "state": "CA",
            "postal_code": "922015667",
            "telephone_number": "760-347-6636",
            "fax_number": "760-342-5987"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "52565 HARRISON ST.",
            "address_2": "SUITE 105",
            "city": "COACHELLA",
            "state": "CA",
            "postal_code": "92236",
            "telephone_number": "760-398-1500",
            "fax_number": "760-398-8474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK A GILLISPIE O D INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-27",
        "last_updated": "2009-06-12",
        "status": "A",
        "authorized_official_last_name": "GILLISPIE",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER / DOCTOR",
        "authorized_official_telephone_number": "760-347-6636",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "8413T",
            "primary": true
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "CA",
            "license": "8413T",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GSD004740",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Yuri Lopez
• Mary Lynsey Chong Lu
• Daisy Maciel
• Rebeca S Magana
• Tracey Manjarrez
• Cristian Martinez, FNP
• Joanna Martinez
• Vanessa Mayorga
• Rebekah Ruth McCammon, MA, APCC
• Dennis Shawn McQuown, M.D.

• Optometrist in Coachella, CA
• Providers in Coachella, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.