Provider Demographics
NPI:1962757344
Name:GILICH ENTERPRISES, LLC
Entity type:Organization
Organization Name:GILICH ENTERPRISES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHNEEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:GILICH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:602-628-3464
Mailing Address - Street 1:2318 PASS ROAD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-4044
Mailing Address - Country:US
Mailing Address - Phone:228-967-7813
Mailing Address - Fax:228-967-7814
Practice Address - Street 1:2318 PASS ROAD
Practice Address - Street 2:SUITE 1
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-4044
Practice Address - Country:US
Practice Address - Phone:228-967-7813
Practice Address - Fax:228-967-7814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-20
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS302G703854Medicare PIN