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General NPI Number Information
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NPI Number | 1861402588
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Entity Type | Individual
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Provider Name | NACONDUS G GAMBLE OPTOMETRIST
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Gender | Female
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 03/13/2017
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Provider Practice Location Address
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Address Line | 345 LINDQUIST RD BUILDING 71
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City | FORT STEWART
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State | GA
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Zip | 31314-5043
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Country | US
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Telephone | 912-876-1101
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Fax |
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Provider Business Mailing Address
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Address Line | 345 LINDQUIST RD BUILDING 71
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City | FORT STEWART
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State | GA
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Zip | 31314-5043
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Country | US
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Telephone | 912-876-1101
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | OEG001839
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License Number State | PA
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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 | 1474
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License Number State | SC
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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 | OPT2433
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License Number State | GA
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