Individual
WENDY S. GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
1512 MAIN ST, BENTON, KY 42025-1607
(270) 527-0951
(270) 527-1316
Mailing address
1512 MAIN ST, BENTON, KY 42025-1607
(270) 527-0951
(270) 527-1316
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
911DT
KY
332H00000X
Eyewear Supplier
911DT
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
77009116
—
KY
Enumeration date
11/21/2006
Last updated
11/14/2013
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