Provider Demographics
NPI:1932224755
Name:GAMBLIN, STEVEN D (OD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:D
Last Name:GAMBLIN
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 1:5101 HINKLEVILLE RD
Mailing Address - Street 2:SUITE 490
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-9049
Mailing Address - Country:US
Mailing Address - Phone:270-441-7332
Mailing Address - Fax:
Practice Address - Street 1:5101 HINKLEVILLE RD
Practice Address - Street 2:SUITE 490
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-9049
Practice Address - Country:US
Practice Address - Phone:270-441-7332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1166-DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9315001Medicare ID - Type Unspecified
KYUD6570Medicare UPIN