Provider Demographics
NPI:1982746293
Name:GAILMARD EYE CENTER LLC
Entity Type:Organization
Organization Name:GAILMARD EYE CENTER LLC
Other - Org Name:GAILMARD OPTOMETRIC ASSOCIATES, P.S.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:AUTHORIZED OFFICIAL/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:BENNETT
Authorized Official - Last Name:GAILMARD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:219-836-1738
Mailing Address - Street 1:630 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-1610
Mailing Address - Country:US
Mailing Address - Phone:219-836-1738
Mailing Address - Fax:219-836-2822
Practice Address - Street 1:630 RIDGE RD
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-1610
Practice Address - Country:US
Practice Address - Phone:219-836-1738
Practice Address - Fax:219-836-2822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001742AB152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0407090001Medicare NSC
IN388370Medicare PIN