Provider Demographics
NPI:1083605745
Name:GIBBS, KARA I (OD)
Entity Type:Individual
Prefix:DR
First Name:KARA
Middle Name:I
Last Name:GIBBS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1576 SWEDE RD
Mailing Address - Street 2:
Mailing Address - City:ASHVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14710-9562
Mailing Address - Country:US
Mailing Address - Phone:716-483-2020
Mailing Address - Fax:716-488-9295
Practice Address - Street 1:20 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701-2004
Practice Address - Country:US
Practice Address - Phone:814-368-7090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001527152W00000X
NYTUV006826-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101142710Medicaid
NY02593093Medicaid
NYRA8531Medicare PIN
PA097446E41Medicare PIN
PA101142710Medicaid