Provider Demographics
NPI:1639258411
Name:GILICH, JOHNEEN (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHNEEN
Middle Name:
Last Name:GILICH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2318 PASS RD STE 1
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-4044
Mailing Address - Country:US
Mailing Address - Phone:228-967-7813
Mailing Address - Fax:228-967-7814
Practice Address - Street 1:235 FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-7587
Practice Address - Country:US
Practice Address - Phone:228-861-6989
Practice Address - Fax:601-799-4685
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1428-569T152W00000X
MS764152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist