Individual provider Active NPI

Nicolette T. Gilmore, O.D.

  • Optometrist
  • Crosby, TX
National Provider Identifier
1275749418
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3857T Issued in TX
Practice address
14215 FM 2100 Rd
Crosby, TX 77532-9152
Phone
(281) 328-7888
Fax
(281) 328-4892
NPI assigned
May 15, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 3857T TX Primary

Addresses

Primary practice location

14215 FM 2100 Rd
Crosby, TX 77532-9152

Mailing address

16610 E Kingscoate Dr
Crosby, TX 77532-4901
Phone (281) 462-0519

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130628000679 TX Practitioner - Optometry 3072753755

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3857TTXMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Vision Max-Baytown PA PastSince Jan 30, 2019 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1179187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1275749418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16610 E KINGSCOATE DR",
            "city": "CROSBY",
            "state": "TX",
            "postal_code": "775324901",
            "telephone_number": "281-462-0519",
            "fax_number": "281-328-4892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14215 FM 2100 RD",
            "city": "CROSBY",
            "state": "TX",
            "postal_code": "775329152",
            "telephone_number": "281-328-7888",
            "fax_number": "281-328-4892"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILMORE",
        "first_name": "NICOLETTE",
        "middle_name": "T.",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "3857T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crosby, TX

Sources for this page

Verify at the official NPI Registry.