Provider Demographics
NPI:1679666747
Name:GABRELS, JASON K (OD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:K
Last Name:GABRELS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1681 THOMPSON BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-1715
Mailing Address - Country:US
Mailing Address - Phone:770-532-0532
Mailing Address - Fax:770-532-0393
Practice Address - Street 1:1681 THOMPSON BRIDGE RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-1715
Practice Address - Country:US
Practice Address - Phone:770-532-0532
Practice Address - Fax:770-532-0393
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1842152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA582554268OtherOTHER COMMERCIAL PAYORS
GA000873232AMedicaid
GAU80557Medicare UPIN
GA582554268OtherOTHER COMMERCIAL PAYORS