Healthcare Provider Details

I. General information

NPI: 1730939851
Provider Name (Legal Business Name): GREG GILES, O.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2024
Last Update Date: 03/22/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7863 LA MESA BLVD STE 202
LA MESA CA
91942-6708
US

IV. Provider business mailing address

7867 ORIEN AVE
LA MESA CA
91941-6300
US

V. Phone/Fax

Practice location:
  • Phone: 619-405-8381
  • Fax: 619-399-2507
Mailing address:
  • Phone: 619-405-8381
  • Fax: 619-399-2507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. GREGORY E GILES
Title or Position: PRESIDENT
Credential: O.D.
Phone: 619-405-8381