Provider Demographics
NPI:1619182615
Name:DAVID R. GIBSON, O.D. & BRYAN P. GIBSON, O.D.
Entity Type:Organization
Organization Name:DAVID R. GIBSON, O.D. & BRYAN P. GIBSON, O.D.
Other - Org Name:DRS. GIBSON, GIBSON, AND MOORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ROGER
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:806-747-1635
Mailing Address - Street 1:2132 50TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79412-2603
Mailing Address - Country:US
Mailing Address - Phone:806-747-1635
Mailing Address - Fax:806-747-5499
Practice Address - Street 1:2132 50TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79412-2603
Practice Address - Country:US
Practice Address - Phone:806-747-1635
Practice Address - Fax:806-747-5499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX 2209T AND 2433TG152W00000X
TX2433TG152W00000X
TX7801TG152W00000X
TX2209T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX093010902Medicaid
TX0672830002Medicare NSC
TXT13438Medicare UPIN
TXT14882Medicare UPIN
TX00E33BMedicare PIN