Provider Demographics
NPI:1093899890
Name:GIBSON, KRISTAN L (OD)
Entity Type:Individual
Prefix:DR
First Name:KRISTAN
Middle Name:L
Last Name:GIBSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:555 E MEDICAL CENTER BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4367
Mailing Address - Country:US
Mailing Address - Phone:281-488-7213
Mailing Address - Fax:281-488-1387
Practice Address - Street 1:3333 BAYSHORE BLVD
Practice Address - Street 2:SUITE 280
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1952
Practice Address - Country:US
Practice Address - Phone:713-943-8671
Practice Address - Fax:713-943-1657
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX07027T152W00000X
FL4130152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX193100005OtherCIGNA GOVERNMENT SERVICES
TX213909901Medicaid
TX213909902Medicaid
TX8L8532Medicare PIN
TX213909902Medicaid