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General NPI Number Information
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NPI Number | 1891682795
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Entity Type | Individual
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Provider Name | GABRIELLE OLIVIA GIBBON OD
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Gender | Female
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Dates
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Enumeration Date | 06/23/2025
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Last Update Date | 06/23/2025
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Provider Practice Location Address
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Address Line | CORNER OF LAMONT ST AND VETERANS WAY
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City | MOUNTAIN HOME
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State | TN
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Zip | 37684
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Country | US
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Telephone | 423-926-1171
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Fax |
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Provider Business Mailing Address
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Address Line | 22156 WEBB DR
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City | ABINGDON
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State | VA
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Zip | 24211
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Country | US
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Telephone | 541-589-0512
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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 | 3946
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License Number State | TN
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