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General NPI Number Information
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NPI Number | 1124079223
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Entity Type | Individual
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Provider Name | NICHOLAS ROY GILMORE O.D.
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Gender | Male
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Dates
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Enumeration Date | 05/13/2006
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Last Update Date | 05/19/2008
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Provider Practice Location Address
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Address Line | 224 S MAIN ST
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City | MILBANK
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State | SD
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Zip | 57252-1809
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Country | US
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Telephone | 605-432-6666
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Fax | 605-432-9255
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Provider Business Mailing Address
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Address Line | 224 S MAIN ST
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City | MILBANK
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State | SD
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Zip | 57252-1809
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Country | US
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Telephone | 605-432-6666
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Fax | 605-432-9255
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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 | 2813
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 583
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License Number State | SD
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