Provider Demographics
NPI:1578034393
Name:GILLESPIE, CHERYL DAWN WILKINS (LDO)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:DAWN WILKINS
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:DAWN
Other - Last Name:GILLESPIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LDO
Mailing Address - Street 1:109 A ST
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:GA
Mailing Address - Zip Code:30286-3127
Mailing Address - Country:US
Mailing Address - Phone:706-656-6774
Mailing Address - Fax:
Practice Address - Street 1:855 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286-3622
Practice Address - Country:US
Practice Address - Phone:706-648-9130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALDO001761156FC0800X, 156FC0801X, 156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact Lens
No156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens Fitter