Individual
MR. JEFFREY ADAM GIBEAULT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LICENSED OPTICIAN
Contact information
Practice address
12 BIRCH RD, VALATIE, NY 12184-4803
(518) 364-3242
Mailing address
12 BIRCH RD, VALATIE, NY 12184-4803
(518) 364-3242
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
008095-1
NY
Other
Enumeration date
04/18/2021
Last updated
04/18/2021
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