Individual
WESLEY C GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LDO
Contact information
Practice address
7720 US HIGHWAY 98 W, SUITE 380, DESTIN, FL 32550-7230
(850) 862-4001
(850) 862-1612
Mailing address
7720 US HIGHWAY 98 W, SUITE 380, DESTIN, FL 32550-7230
(850) 862-4001
(850) 862-1612
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
DO 4476
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
630333100
—
FL
01
—
DO 4476
OPTICIANRY LICENSE
FL
Enumeration date
02/02/2007
Last updated
08/03/2010
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