Individual
THERESA D GIBBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
3695 MAIN ST, WARRENSBURG, NY 12885-1832
(518) 623-2229
Mailing address
28 QUINCY LN, QUEENSBURY, NY 12804-8348
(518) 743-0274
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TUV006098-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02151339
—
NY
Enumeration date
08/17/2006
Last updated
04/16/2013
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