Provider Demographics
NPI:1760562813
Name:GILMAN VORSTER, JENNIFER ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ANN
Last Name:GILMAN VORSTER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:81833 DOCTOR CARREON BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-5590
Mailing Address - Country:US
Mailing Address - Phone:760-863-2241
Mailing Address - Fax:760-863-1919
Practice Address - Street 1:81833 DOCTOR CARREON BLVD STE 5
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-5590
Practice Address - Country:US
Practice Address - Phone:760-863-2241
Practice Address - Fax:760-863-1919
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12255152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0122550Medicaid
CASD0122550Medicaid
CAU95495Medicare UPIN