Provider Demographics
NPI:1407243496
Name:GAIBROIS, NICOLE (OD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:GAIBROIS
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 1:152 BAY ST
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-2329
Mailing Address - Country:US
Mailing Address - Phone:518-792-4140
Mailing Address - Fax:518-792-1300
Practice Address - Street 1:91 SUNSET TRL
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-6710
Practice Address - Country:US
Practice Address - Phone:518-260-0261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-17
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV008246152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist