Provider Demographics
NPI:1205845930
Name:GIBBONS, MARIA (OD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:GIBBONS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6805 ROUTE 9
Mailing Address - Street 2:SUITE 27
Mailing Address - City:RHINEBECK
Mailing Address - State:NY
Mailing Address - Zip Code:12572-1148
Mailing Address - Country:US
Mailing Address - Phone:845-876-2222
Mailing Address - Fax:845-876-2045
Practice Address - Street 1:6805 ROUTE 9
Practice Address - Street 2:SUITE 27
Practice Address - City:RHINEBECK
Practice Address - State:NY
Practice Address - Zip Code:12572-1148
Practice Address - Country:US
Practice Address - Phone:845-876-2222
Practice Address - Fax:845-876-2045
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005821152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC58141Medicare ID - Type Unspecified
NYU68895Medicare UPIN