Provider Demographics
NPI:1578747143
Name:MILBANK EYECARE CENTER, PROF. L.L.C.
Entity Type:Organization
Organization Name:MILBANK EYECARE CENTER, PROF. L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:GILMORE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:605-432-6666
Mailing Address - Street 1:224 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MILBANK
Mailing Address - State:SD
Mailing Address - Zip Code:57252-1809
Mailing Address - Country:US
Mailing Address - Phone:605-432-6666
Mailing Address - Fax:605-432-9255
Practice Address - Street 1:224 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MILBANK
Practice Address - State:SD
Practice Address - Zip Code:57252-1809
Practice Address - Country:US
Practice Address - Phone:605-432-6666
Practice Address - Fax:605-432-9255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD583152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6148570002Medicare NSC