Provider Demographics
NPI:1386932390
Name:GILBERT, MICHAELA CALLAHAN (OD)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:CALLAHAN
Last Name:GILBERT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MICHAELA
Other - Middle Name:DOLAN
Other - Last Name:CALLAHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:7305 E 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80238-2701
Mailing Address - Country:US
Mailing Address - Phone:847-345-2427
Mailing Address - Fax:
Practice Address - Street 1:7305 E 29TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80238-2701
Practice Address - Country:US
Practice Address - Phone:847-345-2427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-12
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2842152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO2846OtherLICENSE