Provider Demographics
NPI:1568088722
Name:CHILDERS, GISELLE PACHECO (OD)
Entity Type:Individual
Prefix:DR
First Name:GISELLE
Middle Name:PACHECO
Last Name:CHILDERS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:GISELLE
Other - Middle Name:PACHECO
Other - Last Name:CHILDERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:996 COUNTY ROAD 57
Mailing Address - Street 2:
Mailing Address - City:SKIPPERVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36374-6863
Mailing Address - Country:US
Mailing Address - Phone:305-803-0825
Mailing Address - Fax:
Practice Address - Street 1:231 E BROAD ST
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:AL
Practice Address - Zip Code:36360-1507
Practice Address - Country:US
Practice Address - Phone:334-566-7172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-23
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-E50152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist