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General NPI Number Information
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NPI Number | 1821208653
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Entity Type | Organization
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Legal Business Name | VAN MOORE OD AND DAVID R. GIBSON OD
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 05/30/2008
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Provider Practice Location Address
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Address Line | 1018 N 1ST ST
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City | LAMESA
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State | TX
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Zip | 79331-5306
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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 | 1018 N 1ST ST
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City | LAMESA
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State | TX
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Zip | 79331-5306
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Country | US
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Telephone | 806-872-8440
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Fax | 806-872-7875
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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 |
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License Number State |
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