Provider Demographics
NPI:1295019735
Name:GIBSON, CRYSTAL ARLENE (OD)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:ARLENE
Last Name:GIBSON
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 1:16152 WHITTIER BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90603-2940
Mailing Address - Country:US
Mailing Address - Phone:562-947-9461
Mailing Address - Fax:
Practice Address - Street 1:10807 JERSEY AVE
Practice Address - Street 2:
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-4316
Practice Address - Country:US
Practice Address - Phone:562-863-7678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-03
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14291152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist