Provider Demographics
NPI:1659785178
Name:GIBBERMAN, ALEX (OD)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:
Last Name:GIBBERMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8211 CORNELL RD
Mailing Address - Street 2:SUITE 510
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45249-2273
Mailing Address - Country:US
Mailing Address - Phone:513-530-0440
Mailing Address - Fax:513-530-0473
Practice Address - Street 1:8211 CORNELL RD
Practice Address - Street 2:SUITE 510
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-2273
Practice Address - Country:US
Practice Address - Phone:513-530-0440
Practice Address - Fax:513-530-0473
Is Sole Proprietor?:No
Enumeration Date:2014-06-12
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6280 T3196152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist