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General NPI Number Information
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NPI Number | 1235599473
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Entity Type | Individual
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Provider Name | ANTHONY WILLIAM GISH OD
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Gender | Male
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Dates
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Enumeration Date | 03/01/2016
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Last Update Date | 03/01/2016
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Provider Practice Location Address
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Address Line | 5415 N MAIN ST
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City | MISHAWAKA
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State | IN
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Zip | 46545-9044
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Country | US
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Telephone | 574-271-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 54630 GILMAN DR
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City | MISHAWAKA
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State | IN
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Zip | 46545-2101
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Country | US
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Telephone | 561-275-2020
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 18003945A
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License Number State | IN
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