Provider Demographics
NPI:1457132599
Name:MCGIBBON, COLIN
Entity Type:Individual
Prefix:
First Name:COLIN
Middle Name:
Last Name:MCGIBBON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 FELTON ST UNIT 208
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-7315
Mailing Address - Country:US
Mailing Address - Phone:857-334-0888
Mailing Address - Fax:
Practice Address - Street 1:10 FELTON ST UNIT 208
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-7315
Practice Address - Country:US
Practice Address - Phone:857-334-0888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist