Individual
MR. CHARLES V GILMORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.P.
Contact information
Practice address
380 LATTABROOK RD, HORSEHEADS, NY 14845-9010
(607) 739-9992
Mailing address
380 LATTABROOK RD, HORSEHEADS, NY 14845-9010
(607) 739-9992
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
006058
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
006058
STATE LICENSE FOR OPTICIA
NY
Enumeration date
07/23/2007
Last updated
07/23/2007
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