Provider Demographics
NPI:1346307055
Name:GIMNESS, WILLIAM C (OD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:C
Last Name:GIMNESS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 E HASTINGS RD STE C
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1977
Mailing Address - Country:US
Mailing Address - Phone:509-328-2632
Mailing Address - Fax:509-324-2377
Practice Address - Street 1:513 E HASTINGS RD STE C
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1977
Practice Address - Country:US
Practice Address - Phone:509-328-2632
Practice Address - Fax:509-324-2377
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2019-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WATX00001225152W00000X
WAOD00001225152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2035277Medicaid
WAGAB35074Medicare ID - Type Unspecified
WAT02299Medicare UPIN