Provider Demographics
NPI:1518107598
Name:GIBSON, JANA LOU
Entity Type:Individual
Prefix:MRS
First Name:JANA
Middle Name:LOU
Last Name:GIBSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 JODIE DR
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76087-4241
Mailing Address - Country:US
Mailing Address - Phone:361-876-9406
Mailing Address - Fax:
Practice Address - Street 1:929 JODIE DR
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76087-4241
Practice Address - Country:US
Practice Address - Phone:361-876-9406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact Lens