Provider Demographics
NPI:1205955796
Name:WILLIAM C. GIMNESS, O.D., P.S.
Entity type:Organization
Organization Name:WILLIAM C. GIMNESS, O.D., P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:GIMNESS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:509-935-2020
Mailing Address - Street 1:PO BOX 836
Mailing Address - Street 2:
Mailing Address - City:CHEWELAH
Mailing Address - State:WA
Mailing Address - Zip Code:99109-0836
Mailing Address - Country:US
Mailing Address - Phone:509-935-2020
Mailing Address - Fax:509-935-6795
Practice Address - Street 1:306 N. PARK STREET
Practice Address - Street 2:
Practice Address - City:CHEWELAH
Practice Address - State:WA
Practice Address - Zip Code:99109-0836
Practice Address - Country:US
Practice Address - Phone:509-935-2020
Practice Address - Fax:509-935-6795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4665600001OtherDME NUMBER