Provider Demographics
NPI:1356412886
Name:GAMBLE, CHRISTOPHER M (OD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:M
Last Name:GAMBLE
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 1:1008 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-2371
Mailing Address - Country:US
Mailing Address - Phone:937-599-5315
Mailing Address - Fax:937-599-1185
Practice Address - Street 1:1008 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-2371
Practice Address - Country:US
Practice Address - Phone:937-599-5315
Practice Address - Fax:937-599-1185
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4696152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHC9354411OtherMEDICARE PTAN
OH300285181027Medicaid
OH0215387Medicaid
OHU58782Medicare UPIN
OH0215387Medicaid
OHC9354411OtherMEDICARE PTAN
OH300285181027Medicaid
5990490001Medicare NSC