MEDICARE: MRS. JENNIFER GIBSON UHL O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	T2636	TN

General Provider Information

NPI Number	:	1477570349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER GIBSON UHL O.D.

Provider Business Mailing Address
First Line	:	131 INDIAN LAKE RD
Second Line	:
City	:	HENDERSONVILLE
State	:	TN
Zip	:	37075-3866
Country	:	US
Telephone Number	:	615-824-5486
Fax Number	:	615-824-1770

Provider Business Practice Location Address
First Line	:	131 INDIAN LAKE RD
Second Line	:
City	:	HENDERSONVILLE
State	:	TN
Zip	:	37075-3866
Country	:	US
Telephone Number	:	615-824-5486
Fax Number	:	615-824-1770

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	07/09/2007

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