Provider Demographics
NPI:1265706816
Name:GILBERT EYECARE
Entity type:Organization
Organization Name:GILBERT EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:630-730-6683
Mailing Address - Street 1:906 E 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-2802
Mailing Address - Country:US
Mailing Address - Phone:630-730-6683
Mailing Address - Fax:303-344-9120
Practice Address - Street 1:14200 E ALAMEDA AVE
Practice Address - Street 2:SUITE 1029
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-2511
Practice Address - Country:US
Practice Address - Phone:720-443-1029
Practice Address - Fax:303-344-9120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-29
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2846152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO319458Medicare PIN