Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | OD 1647TX | WA |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 1764ATI | OR |
NPI | 1043326572 |
---|---|
Provider Name | Thomas Hugh Gibbs |
First Address | Portland, OR 97227-1106 |
Second Address | Portland, OR 97227-1106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 08/07/2007 |