Provider Demographics
NPI:1619052834
Name:GIBSON'S EYE WORKS INC.
Entity Type:Organization
Organization Name:GIBSON'S EYE WORKS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-261-2221
Mailing Address - Street 1:3901 HARDY ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1636
Mailing Address - Country:US
Mailing Address - Phone:601-261-2221
Mailing Address - Fax:601-264-3893
Practice Address - Street 1:3901 HARDY ST
Practice Address - Street 2:SUITE 130
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1636
Practice Address - Country:US
Practice Address - Phone:601-261-2221
Practice Address - Fax:601-264-3893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS018-14124-2332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06376211Medicaid
MS4936300001Medicaid
MS=========OtherTAX IDENTIFICATION NUMBER