Provider Demographics
NPI:1558873299
Name:GIBBS AND GOLDSHMIDT OPTICAL
Entity Type:Organization
Organization Name:GIBBS AND GOLDSHMIDT OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEONIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDSHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-967-8747
Mailing Address - Street 1:460 NEPTUNE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-4301
Mailing Address - Country:US
Mailing Address - Phone:347-967-8747
Mailing Address - Fax:347-221-1220
Practice Address - Street 1:460 NEPTUNE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-4301
Practice Address - Country:US
Practice Address - Phone:347-967-8747
Practice Address - Fax:347-221-1220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service