Individual provider Active NPI

Neil Bennett Gailmard, O.D.

  • Optometrist
  • Munster, IN
National Provider Identifier
1164564530
Registry record updated Apr 6, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
18001742AB Issued in IN
Practice address
630 Ridge Rd
Munster, IN 46321-1610
Phone
(219) 836-1738
Fax
(219) 836-2822
NPI assigned
Feb 13, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 18001742AB IN Primary

Addresses

Primary practice location

630 Ridge Rd
Munster, IN 46321-1610

Mailing address

630 Ridge Rd
Munster, IN 46321-1610
Phone (219) 836-1738

Other identifiers 1

IdentifierTypeStateIssuer
0407090001OtherINDME MAC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
18001742ABINMDOptometrist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1238976000000",
    "number": "1164564530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 RIDGE RD",
            "city": "MUNSTER",
            "state": "IN",
            "postal_code": "463211610",
            "telephone_number": "219-836-1738",
            "fax_number": "219-836-2822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 RIDGE RD",
            "city": "MUNSTER",
            "state": "IN",
            "postal_code": "463211610",
            "telephone_number": "219-836-1738",
            "fax_number": "219-836-2822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAILMARD",
        "first_name": "NEIL",
        "middle_name": "BENNETT",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-13",
        "last_updated": "2009-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18001742AB",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DME MAC",
            "identifier": "0407090001",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Munster, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.