Provider Demographics
NPI:1649725375
Name:ANTHONY W. GISH O.D., P.C.
Entity type:Organization
Organization Name:ANTHONY W. GISH O.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:GISH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:574-286-4298
Mailing Address - Street 1:3750 E VIA PALOMITA
Mailing Address - Street 2:APT 20202
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-3355
Mailing Address - Country:US
Mailing Address - Phone:574-286-4298
Mailing Address - Fax:
Practice Address - Street 1:5850 E BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-3902
Practice Address - Country:US
Practice Address - Phone:520-790-0546
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2104152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty