Kyle Morgan Gillespie, O.D.
Individual provider Active NPI Optometrist · Quincy, WA
NPI 1649433459 · NPPES record last updated Nov 3, 2022
Key facts
- NPI
- 1649433459
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- OD60178254 (WA)
- Practice address
- 701 2ND Ave SE
Quincy, WA 98848-1531 - Phone
- (509) 787-1581
- NPI assigned
- Jul 2, 2008
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- University Alabama Birmingham - School of Optometry, 2008
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
701 2ND Ave SE
Quincy, WA 98848-1531
Phone (509) 787-1581
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 13 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in UT, WA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100429000185 | UT | Practitioner - Optometry | 1052473097 | Reassigns benefits to 1 organization |
| I20101106000037 | WA | Practitioner - Optometry | 1052473097 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S-B76-TA-792 | AL | MD | Optometrist |
| 657 | NV | MD | Optometrist |
| 7240166-9934 | UT | MD | Optometrist |
| OD60178254 | WA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kyle M Gillespie O D LTD | Optometrist | Current |
Accepting new patients |
| DW Family Eye Care PLLC | Optometrist | Current | Accepting new patients |
| Kyle M. Gillespie, O.D., LTD. | Optometrist | Past | Accepting new patients |
Locations
701 2nd Ave SE
Quincy, WA 98848
Phone (509) 787-1581
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 657 | NV | |
| Optometrist | 152W00000X | S-B76-TA-792 | AL | |
| Optometrist | 152W00000X | 7240166-9934 | UT | |
| Optometrist | 152W00000X | OD60178254 | WA | Yes |
Addresses
Primary practice location
701 2ND Ave SE
Quincy, WA 98848-1531
Mailing address
701 2ND Ave SE
Quincy, WA 98848-1531
Phone (509) 787-1581
Other practice location 1
326 W 4100 N
Provo, UT 84604-6212
Phone (801) 709-4532
Other providers in Quincy, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 3, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.