Provider Demographics
NPI:1235160581
Name:GILMAN, BETH (OD)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:
Last Name:GILMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 E CENTRAL AVE
Mailing Address - Street 2:STE C
Mailing Address - City:QUINCY
Mailing Address - State:CA
Mailing Address - Zip Code:95971-9718
Mailing Address - Country:US
Mailing Address - Phone:530-283-2020
Mailing Address - Fax:530-283-2102
Practice Address - Street 1:68 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:CA
Practice Address - Zip Code:95971-9718
Practice Address - Country:US
Practice Address - Phone:530-283-2020
Practice Address - Fax:530-283-2102
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7446 TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0276140001Medicare NSC