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NPI Code Detail

MEDICARE: DR. EILEEN MARIE GILMOUR O.D.

MEDICARE: DR. EILEEN MARIE GILMOUR O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist2492NC

General Provider Information

NPI Number : 1679092498
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EILEEN MARIE GILMOUR O.D.
Provider Business Mailing Address
First Line : 711 S TWIN OAKS VALLEY RD
Second Line : APT 296
City : SAN MARCOS
State : CA
Zip : 92078-7328
Country : US
Telephone Number : 206-708-9489
Fax Number :
Provider Business Practice Location Address
First Line : 5619 CAROLINA BEACH RD STE 110
Second Line :
City : WILMINGTON
State : NC
Zip : 28412-2814
Country : US
Telephone Number : 910-790-0212
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2017
Last Update Date : 07/02/2020

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