Provider Demographics
NPI:1992741557
Name:DERSCHEID, GAIL BASS (OD)
Entity type:Individual
Prefix:DR
First Name:GAIL
Middle Name:BASS
Last Name:DERSCHEID
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:GAIL
Other - Middle Name:JEAN
Other - Last Name:BASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:5425 E BELL RD
Mailing Address - Street 2:SUITE 135
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-6007
Mailing Address - Country:US
Mailing Address - Phone:480-614-0466
Mailing Address - Fax:480-614-5435
Practice Address - Street 1:5425 E BELL RD
Practice Address - Street 2:STE 135
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-6007
Practice Address - Country:US
Practice Address - Phone:602-404-2005
Practice Address - Fax:602-466-2336
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ824152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU13560Medicare UPIN
AZZ71088Medicare PIN