Provider Demographics
NPI:1770655920
Name:GILMAN, ELLEN (OD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
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:ONE WASHINGTON STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481
Mailing Address - Country:US
Mailing Address - Phone:617-332-1471
Mailing Address - Fax:617-332-2735
Practice Address - Street 1:ONE WASHINGTON STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481
Practice Address - Country:US
Practice Address - Phone:617-332-1471
Practice Address - Fax:617-332-2735
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2679152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0334995Medicaid
171358Medicare ID - Type Unspecified
MA0334995Medicaid