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General NPI Number Information
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NPI Number | 1619182615
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Entity Type | Organization
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Legal Business Name | DAVID R. GIBSON, O.D. & BRYAN P. GIBSON, O.D.
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Dates
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Enumeration Date | 05/12/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2132 50TH ST
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City | LUBBOCK
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State | TX
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Zip | 79412-2603
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Country | US
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Telephone | 806-747-1635
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Fax | 806-747-5499
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Provider Business Mailing Address
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Address Line | 2132 50TH ST
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City | LUBBOCK
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State | TX
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Zip | 79412-2603
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Country | US
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Telephone | 806-747-1635
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Fax | 806-747-5499
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Authorized Official
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Title or Position | PARTNER
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Name | DR. DAVID ROGER GIBSON
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Credential | O.D.
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Telephone | 806-747-1635
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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 | 2433TG
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 7801TG
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2209T
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TX 2209T AND 2433TG
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License Number State | TX
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