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General NPI Number Information
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NPI Number | 1619052834
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Entity Type | Organization
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Legal Business Name | GIBSON'S EYE WORKS INC.
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 10/07/2015
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Provider Practice Location Address
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Address Line | 3901 HARDY ST SUITE 130
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City | HATTIESBURG
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State | MS
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Zip | 39402-1636
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Country | US
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Telephone | 601-261-2221
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Fax | 601-264-3893
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Provider Business Mailing Address
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Address Line | 3901 HARDY ST SUITE 130
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City | HATTIESBURG
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State | MS
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Zip | 39402-1636
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Country | US
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Telephone | 601-261-2221
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Fax | 601-264-3893
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Authorized Official
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Title or Position | OWNER
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Name | MR. STEVE GIBSON
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Credential |
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Telephone | 601-261-2221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 018-14124-2
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License Number State | MS
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