Provider Demographics
NPI:1477991263
Name:KYLE M. GILLESPIE, O.D., LTD.
Entity Type:Organization
Organization Name:KYLE M. GILLESPIE, O.D., LTD.
Other - Org Name:GILLESPIE EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:GILLESPIE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:509-787-1581
Mailing Address - Street 1:701 2ND AVE SE
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:WA
Mailing Address - Zip Code:98848-1531
Mailing Address - Country:US
Mailing Address - Phone:509-787-1581
Mailing Address - Fax:
Practice Address - Street 1:123 HOSPITAL WAY
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:WA
Practice Address - Zip Code:98812-0015
Practice Address - Country:US
Practice Address - Phone:509-787-1581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KYLE M. GILLESPIE, O.D., LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty