Provider Demographics
NPI:1063418721
Name:V. EUGENE KILMORE, JR., M.D., P.C.
Entity type:Organization
Organization Name:V. EUGENE KILMORE, JR., M.D., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WHETTEN
Authorized Official - Last Name:PRATT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-697-1414
Mailing Address - Street 1:890 CENTURY DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-4375
Mailing Address - Country:US
Mailing Address - Phone:717-697-1414
Mailing Address - Fax:717-697-4921
Practice Address - Street 1:890 CENTURY DR
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-4375
Practice Address - Country:US
Practice Address - Phone:717-697-1414
Practice Address - Fax:717-697-4921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-27
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X, 207W00000X
PAMD019118E261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5798509OtherAETNA PPO
PA558206OtherBLUE SHIELD
PA78848OtherAETNA HMO
PA7990388OtherGATEWAY
PA727679OtherBLUE SHIELD
PA990388OtherKHP/KSB
PA02286000OtherCAPITAL BLUE CROSS
PA990388OtherKHP/KSB
PA=========OtherALL OTHER INSURANCES
PA558206Medicare PIN
727679Medicare PIN
PACF0050Medicare PIN
PAC27885Medicare UPIN
PA558206OtherBLUE SHIELD