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General NPI Number Information
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NPI Number | 1912907585
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Entity Type | Organization
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Legal Business Name | GABRIELE EYE INSTITUTE
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Dates
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Enumeration Date | 07/26/2005
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Last Update Date | 05/30/2008
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Provider Practice Location Address
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Address Line | 3730 EDISON LAKES PKWY
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City | MISHAWAKA
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State | IN
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Zip | 46545-3424
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Country | US
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Telephone | 574-252-7757
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Fax | 574-254-2638
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Provider Business Mailing Address
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Address Line | 3730 EDISON LAKES PKWY
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City | MISHAWAKA
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State | IN
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Zip | 46545-3424
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Country | US
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Telephone | 574-252-7757
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Fax | 574-254-2638
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Authorized Official
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Title or Position | PRESIDENT
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Name | PHILIP J GABRIELE
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Credential | M.D.
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Telephone | 574-252-7757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 01050631A
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License Number State | IN
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