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General NPI Number Information
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NPI Number | 1336318807
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Entity Type | Organization
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Legal Business Name | GREGORY B. MCMAHILL, OD, AN OPTOMETRIC CORPORATION
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Dates
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Enumeration Date | 02/28/2008
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Last Update Date | 09/23/2011
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Provider Practice Location Address
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Address Line | 72800 DINAH SHORE DR
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City | PALM DESERT
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State | CA
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Zip | 92211-0814
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Country | US
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Telephone | 760-202-0100
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Fax | 760-202-0121
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Provider Business Mailing Address
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Address Line | 72800 DINAH SHORE DR
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City | PALM DESERT
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State | CA
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Zip | 92211-0814
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Country | US
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Telephone | 760-202-0100
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Fax | 760-202-0121
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GREGORY BRIAN MCMAHILL
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Credential | O.D.
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Telephone | 760-202-0100
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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 | OPT9489TPA
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License Number State | CA
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