Provider Demographics
NPI:1740515832
Name:PHILIPP, GAILE KRISTINE
Entity type:Individual
Prefix:MRS
First Name:GAILE
Middle Name:KRISTINE
Last Name:PHILIPP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GAILE
Other - Middle Name:KRISTINE
Other - Last Name:OURADA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:3001 WHITE BEAR AVE N STE 1050
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-1283
Mailing Address - Country:US
Mailing Address - Phone:651-770-3923
Mailing Address - Fax:651-770-5316
Practice Address - Street 1:3001 WHITE BEAR AVE N STE 1050
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55109-1283
Practice Address - Country:US
Practice Address - Phone:651-770-3923
Practice Address - Fax:651-770-5316
Is Sole Proprietor?:No
Enumeration Date:2009-10-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3246152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3246OtherMINNESOTA OPTOMETRIC LICENSE