Provider Demographics
NPI:1366505588
Name:MCMAHILL, GREGORY B (OD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:B
Last Name:MCMAHILL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:GREGORY
Other - Middle Name:B
Other - Last Name:MCMAHILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:72800 DINAH SHORE DR
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-0814
Mailing Address - Country:US
Mailing Address - Phone:760-202-0100
Mailing Address - Fax:760-202-0121
Practice Address - Street 1:72800 DINAH SHORE DR
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-0814
Practice Address - Country:US
Practice Address - Phone:760-202-0100
Practice Address - Fax:760-202-0121
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 9489 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU13914Medicare UPIN
CASD0094890Medicare ID - Type Unspecified
CAEB839ZMedicare PIN