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NPI Code Detail

MEDICARE: CHARLES GIBSON O.D.

MEDICARE: CHARLES GIBSON 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
1152W00000XOptometrist2069AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
147859OTHERARKANSAS BCBS
207225OTHERSPECTERA
326766OTHERMEDICAL EYE SERVICES
456908OTHERSUPERIOR VISION PLAN
5923045OTHERBLOCK VISION
638855OTHERAVESIS
7041012OTHERNATIONAL VISION ASSOCIATI
81454016OTHEROPTICHOICE
947678OTHERDAVIS VISION
10710739595001OTHEROKLAHOMA BCBS

General Provider Information

NPI Number : 1972673432
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES GIBSON O.D.
Provider Business Mailing Address
First Line : 2425 ZERO ST
Second Line :
City : FORT SMITH
State : AR
Zip : 72901-8663
Country : US
Telephone Number : 479-649-5900
Fax Number : 479-649-6724
Provider Business Practice Location Address
First Line : 2425 ZERO ST
Second Line :
City : FORT SMITH
State : AR
Zip : 72901-8663
Country : US
Telephone Number : 479-649-5900
Fax Number : 479-649-6724
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2006
Last Update Date : 07/08/2007

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