Provider Demographics
NPI:1053633248
Name:GISBERT, AMIE SUSSAN (OD)
Entity Type:Individual
Prefix:DR
First Name:AMIE
Middle Name:SUSSAN
Last Name:GISBERT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4914 MEADOWGLEN DR
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7667
Mailing Address - Country:US
Mailing Address - Phone:281-435-7968
Mailing Address - Fax:281-286-2826
Practice Address - Street 1:9215 BROADWAY ST STE 119
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-8987
Practice Address - Country:US
Practice Address - Phone:281-997-2015
Practice Address - Fax:281-977-2016
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-16
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7400TG152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management