Provider Demographics
NPI:1649433459
Name:GILLESPIE, KYLE MORGAN (OD)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:MORGAN
Last Name:GILLESPIE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 2ND AVE SE
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:WA
Mailing Address - Zip Code:98848-1531
Mailing Address - Country:US
Mailing Address - Phone:509-787-1581
Mailing Address - Fax:
Practice Address - Street 1:701 2ND AVE SE
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:WA
Practice Address - Zip Code:98848-1531
Practice Address - Country:US
Practice Address - Phone:509-787-1581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV657152W00000X
ALS-B76-TA-792152W00000X
UT7240166-9934152W00000X
WAOD60178254152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist