# THOMAS M. GIBBONS, OD, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1992142418
- **Authorized official:** DR. THOMAS MATTHEW GIBBONS OD (OWNER)
- **Authorized official phone:** (573) 651-0660

## Contact information

- **Practice address:** 115 S BROADVIEW ST, CAPE GIRARDEAU, MO 63703-5760
- **Practice address phone:** (573) 651-0660
- **Mailing address:** 115 S BROADVIEW ST, CAPE GIRARDEAU, MO 63703-5760
- **Mailing address phone:** (573) 651-0660

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | T03048 | MO | Yes |

## Other

- **Enumeration date:** 05/23/2013
- **Last updated:** 09/17/2013