Provider Demographics
NPI:1821208653
Name:VAN MOORE OD AND DAVID R. GIBSON OD
Entity Type:Organization
Organization Name:VAN MOORE OD AND DAVID R. GIBSON OD
Other - Org Name:DRS. ARMISTEAD, MOORE AND GIBSON
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 1:1018 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:LAMESA
Mailing Address - State:TX
Mailing Address - Zip Code:79331-5306
Mailing Address - Country:US
Mailing Address - Phone:806-872-8440
Mailing Address - Fax:806-872-7875
Practice Address - Street 1:1018 N 1ST ST
Practice Address - Street 2:
Practice Address - City:LAMESA
Practice Address - State:TX
Practice Address - Zip Code:79331-5306
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:2007-05-23
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX093010901Medicaid
TX0672830001Medicare NSC
TX093010901Medicaid