Provider Demographics
NPI:1770667974
Name:GILLMORE, JOHN JAMES (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JAMES
Last Name:GILLMORE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1787 WILI PA LOOP STE 8
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-1271
Mailing Address - Country:US
Mailing Address - Phone:808-242-8988
Mailing Address - Fax:
Practice Address - Street 1:1787 WILI PA LOOP STE 8
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1271
Practice Address - Country:US
Practice Address - Phone:808-242-8988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI361152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH130311Medicare ID - Type Unspecified
HIU14872Medicare UPIN
HI0000PGBLZMedicare ID - Type Unspecified