Provider Demographics
NPI:1275749418
Name:GILMORE, NICOLETTE T (OD)
Entity Type:Individual
Prefix:DR
First Name:NICOLETTE
Middle Name:T
Last Name:GILMORE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:16610 E KINGSCOATE DR
Mailing Address - Street 2:
Mailing Address - City:CROSBY
Mailing Address - State:TX
Mailing Address - Zip Code:77532-4901
Mailing Address - Country:US
Mailing Address - Phone:281-462-0519
Mailing Address - Fax:281-328-4892
Practice Address - Street 1:14215 FM 2100 RD
Practice Address - Street 2:
Practice Address - City:CROSBY
Practice Address - State:TX
Practice Address - Zip Code:77532-9152
Practice Address - Country:US
Practice Address - Phone:281-328-7888
Practice Address - Fax:281-328-4892
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3857T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist