Provider Demographics
NPI:1528600970
Name:GIBSON, SARA ROSE (OD)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:ROSE
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 1:12907 HIGHWAY 60
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:IN
Mailing Address - Zip Code:47143-9608
Mailing Address - Country:US
Mailing Address - Phone:812-595-0266
Mailing Address - Fax:
Practice Address - Street 1:800 N GREEN RIVER RD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-2471
Practice Address - Country:US
Practice Address - Phone:812-475-1946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18004198A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist