Provider Demographics
NPI:1972188803
Name:GILA OPTICAL, INC.
Entity Type:Organization
Organization Name:GILA OPTICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:S
Authorized Official - Last Name:MITTICA
Authorized Official - Suffix:
Authorized Official - Credentials:ABOC
Authorized Official - Phone:575-388-4464
Mailing Address - Street 1:604 W SPRING ST
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-4847
Mailing Address - Country:US
Mailing Address - Phone:575-388-4464
Mailing Address - Fax:575-388-2014
Practice Address - Street 1:604 W SPRING ST
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-4847
Practice Address - Country:US
Practice Address - Phone:575-388-4464
Practice Address - Fax:575-388-2014
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GILA EYECARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty