Provider Demographics
NPI:1851419790
Name:GIBSON, HERBERT (OD)
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:
Last Name:GIBSON
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 1:17 SARDIS RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-8536
Mailing Address - Country:US
Mailing Address - Phone:828-665-0603
Mailing Address - Fax:828-665-0676
Practice Address - Street 1:17 SARDIS RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-8536
Practice Address - Country:US
Practice Address - Phone:828-665-0603
Practice Address - Fax:828-665-0676
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0813152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89093N4Medicaid