Kyle M Gillespie O D LTD
Organization Active NPI Optometrist · Quincy, WA
NPI 1962728295 · NPPES record last updated Sep 6, 2023
Key facts
- NPI
- 1962728295
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- OD60178254 (WA)
- Legal business name
- KYLE M GILLESPIE O D LTD
- Practice address
- 701 2ND Ave SE
Quincy, WA 98848-1531 - Phone
- (509) 787-1581
- Fax
- (509) 787-9176
- NPI assigned
- Apr 12, 2010
- Organization subpart
- No
Authorized official
- Name
- Kyle M Gillespie, OD
- Title
- President
- Phone
- (509) 797-3641
Other NPIs on the same Medicare enrollment 2
Subparts reporting this organization as parent 2
Practitioners 1
-
Kyle Morgan Gillespie, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WA, UT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20101106000033 | WA | Part B Supplier - Clinic/Group Practice | 0941337620 |
Receives reassigned benefits from 1 practitioner 2 other NPIs on this enrollment Practice locations: Brewster, WA; Quincy, WA |
| O20220719003526 | UT | Part B Supplier - Clinic/Group Practice | 0941337620 |
Receives reassigned benefits from 1 practitioner Practice locations: Provo, UT |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | OD60178254 | WA | Yes |
Addresses
Primary practice location
701 2ND Ave SE
Quincy, WA 98848-1531
Mailing address
326 W 4100 N
Provo, UT 84604-6212
Phone (509) 797-3641
Other practice location 1
326 W 4100 N
Provo, UT 84604-6212
Phone (801) 709-4532
Other names
- Gillespie Eye Care
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 Sep 6, 2023. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.