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General NPI Number Information
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NPI Number | 1912010430
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Entity Type | Individual
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Provider Name | THERESA D GIBBS OD
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Gender | Female
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Dates
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Enumeration Date | 08/17/2006
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Last Update Date | 04/16/2013
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Provider Practice Location Address
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Address Line | 3695 MAIN ST
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City | WARRENSBURG
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State | NY
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Zip | 12885-1832
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Country | US
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Telephone | 518-623-2229
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Fax |
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Provider Business Mailing Address
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Address Line | 28 QUINCY LN
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City | QUEENSBURY
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State | NY
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Zip | 12804-8348
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Country | US
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Telephone | 518-743-0274
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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 | TUV006098-1
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License Number State | NY
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