Provider Demographics
NPI:1821000258
Name:GILMORE, VIRGINIA (OD)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:
Last Name:GILMORE
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:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:WINTERPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04496-0421
Mailing Address - Country:US
Mailing Address - Phone:207-223-5555
Mailing Address - Fax:
Practice Address - Street 1:663 STILLWATER AVE
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3642
Practice Address - Country:US
Practice Address - Phone:207-262-7192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT869152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME022304OtherANTHEM
MEU76322Medicare UPIN
MEME0451Medicare ID - Type Unspecified