Provider Demographics
NPI:1952166670
Name:GILLISPIE, GRACE (OD)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:GILLISPIE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4130 ANDREW JACKSON PKWY
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-2203
Mailing Address - Country:US
Mailing Address - Phone:615-885-2027
Mailing Address - Fax:
Practice Address - Street 1:4130 ANDREW JACKSON PKWY
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-2203
Practice Address - Country:US
Practice Address - Phone:615-885-2027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-21
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3890152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist