Provider Demographics
NPI:1922242825
Name:GILMARTIN, PAMELA S (OD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:S
Last Name:GILMARTIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:M
Other - Last Name:SNYDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:822 CASS ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-3230
Mailing Address - Country:US
Mailing Address - Phone:231-946-6095
Mailing Address - Fax:231-252-4404
Practice Address - Street 1:822 CASS ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-3230
Practice Address - Country:US
Practice Address - Phone:231-946-6095
Practice Address - Fax:231-252-4404
Is Sole Proprietor?:No
Enumeration Date:2009-04-23
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009014769152WV0400X, 152W00000X, 152WP0200X
MI4901004513152WX0102X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1922242825Medicaid
MO016300002Medicare PIN
MO1922242825Medicaid
MO074730008Medicare PIN