Active NPI
David Thomas Gilmore, O.D.
- Optometrist
- Portage, IN
National Provider Identifier
1477690022
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 18001695B
- Practice address
- 6097 US Highway 6
Portage, IN 46368-5046 - Phone
- (219) 763-1538
- NPI assigned
- Jan 31, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 18001695B | IN | Primary |
Addresses
Primary practice location
6097 US Highway 6
Portage, IN 46368-5046
Mailing address
537 Raven Rd
Valparaiso, IN 46385-8133
Phone (219) 759-3092
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18001695B | IN | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170201600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1477690022",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "537 RAVEN RD",
"city": "VALPARAISO",
"state": "IN",
"postal_code": "463858133",
"telephone_number": "219-759-3092"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6097 US HIGHWAY 6",
"city": "PORTAGE",
"state": "IN",
"postal_code": "463685046",
"telephone_number": "219-763-1538"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GILMORE",
"first_name": "DAVID",
"middle_name": "THOMAS",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-31",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "IN",
"license": "18001695B",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portage, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.