Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 9100T | TX |
NPI | 1013466796 |
---|---|
Provider Name | Scott Gabreski |
First Address | Fort Hood, TX 76544 |
Second Address | Fort Hood, TX 76544 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2016 |
Last Update Date | 16/07/2020 |