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General NPI Number Information
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NPI Number | 1053588780
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Entity Type | Organization
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Legal Business Name | GAMBINO EYE ASSOCIATES, INC.
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Dates
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Enumeration Date | 05/12/2008
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Last Update Date | 05/12/2008
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Provider Practice Location Address
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Address Line | 4150 BELT LINE RD STE 200
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City | ADDISON
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State | TX
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Zip | 75001-4354
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Country | US
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Telephone | 972-386-9646
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Fax |
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Provider Business Mailing Address
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Address Line | 4150 BELT LINE RD STE 200
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City | ADDISON
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State | TX
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Zip | 75001-4354
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Country | US
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Telephone | 972-386-9646
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHEL JOSEPH GAMBINO
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Credential | O. D.
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Telephone | 972-386-9646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4387T
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License Number State | TX
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