Provider Demographics
NPI:1427797661
Name:GILBERT, KAITLIN (OD)
Entity type:Individual
Prefix:DR
First Name:KAITLIN
Middle Name:
Last Name:GILBERT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:679 KIDDER ST
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18702-6973
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:679 KIDDER ST
Practice Address - Street 2:
Practice Address - City:WILKES BARRE TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18702-6973
Practice Address - Country:US
Practice Address - Phone:570-704-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-03
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003947152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist