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1093899890 NPI number — KRISTAN L GIBSON OD

NPI Number: 1093899890
Health Care Provider/Practitioner: KRISTAN L GIBSON OD

Information about “1093899890” NPI (KRISTAN L GIBSON OD) exists in 1093899890 in HTML format HTML  |  1093899890 in plain Text format TXT  |  1093899890 in PDF (Portable Document Format) PDF  |  1093899890 in an XML format XML  formats.

NPI Number : 1093899890 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1093899890",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GIBSON",
    "FirstName": "KRISTAN",
    "MiddleName": "L",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "OD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "555 E MEDICAL CENTER BLVD",
    "SecondLineMailingAddress": "SUITE 101",
    "MailingAddressCityName": "WEBSTER",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "77598-4367",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "281-488-7213",
    "MailingAddressFaxNumber": "281-488-1387",
    "FirstLinePracticeLocationAddress": "3333 BAYSHORE BLVD",
    "SecondLinePracticeLocationAddress": "SUITE 280",
    "PracticeLocationAddressCityName": "PASADENA",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "77504-1952",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "713-943-8671",
    "PracticeLocationAddressFaxNumber": "713-943-1657",
    "EnumerationDate": "10/25/2006",
    "LastUpdateDate": "10/25/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "152W00000X",
          "TaxonomyName": "Optometrist",
          "LicenseNumber": "07027T",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "152W00000X",
          "TaxonomyName": "Optometrist",
          "LicenseNumber": "4130",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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