Provider Demographics
NPI:1730304247
Name:GABRIEL, DAVID C (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:C
Last Name:GABRIEL
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 1:8772 BROWER LAKE RD NE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-8321
Mailing Address - Country:US
Mailing Address - Phone:616-874-7118
Mailing Address - Fax:
Practice Address - Street 1:8772 BROWER LAKE RD NE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-8321
Practice Address - Country:US
Practice Address - Phone:616-874-7118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003010152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM60130010Medicare PIN