=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386531044
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES GRANT GAMBLE OD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/23/2025
-----------------------------------------------------
Last Update Date | 06/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 116 EAST CEDAR STREET
-----------------------------------------------------
City | BONNER SPRINGS
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-422-7781
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11970 S PFLUMM RD APT 8103
-----------------------------------------------------
City | OLATHE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66062-9661
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-378-8874
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 2025019885
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------