Provider Demographics
NPI:1902245202
Name:GILMORE, NATHAN DUANE (OD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:DUANE
Last Name:GILMORE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:625 E SAVIDGE ST
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-1956
Mailing Address - Country:US
Mailing Address - Phone:616-844-5650
Mailing Address - Fax:616-844-5696
Practice Address - Street 1:951 SEMINOLE RD
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49441-4341
Practice Address - Country:US
Practice Address - Phone:231-780-4700
Practice Address - Fax:231-780-4722
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2020-10-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4901004757152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist