Individual provider · NPI-1
Wesley C Gibson, LDO
Technician/Technologist, Optician · Destin, FL
NPI number1386782183
StatusActive
Last updated in NPPESAug 3, 2010
Details
- NPI
- 1386782183
- Entity type
- Individual (NPI-1)
- Name
- Wesley C Gibson
- Credential
- LDO
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Feb 2, 2007
- Last updated
- Aug 3, 2010
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 156FX1800X | Technician/Technologist, Optician | DO 4476 | FL | Yes |
Practice location
7720 Us Highway 98 WSuite 380
Destin, FL 32550-7230
Phone 850-862-4001 · Fax 850-862-1612
Mailing address
7720 Us Highway 98 WSuite 380
Destin, FL 32550-7230
Phone 850-862-4001 · Fax 850-862-1612
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