Basic Information
| Provider Information | |||||||||
| NPI: | 1255063780 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GABHART | ||||||||
| FirstName: | ANN | ||||||||
| MiddleName: | MARIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 112 OSBOURNE WAY | ||||||||
| Address2: | |||||||||
| City: | GEORGETOWN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403249636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028671224 | ||||||||
| FaxNumber: | 5028671226 | ||||||||
| Practice Location | |||||||||
| Address1: | 112 OSBOURNE WAY | ||||||||
| Address2: | |||||||||
| City: | GEORGETOWN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403249636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028671224 | ||||||||
| FaxNumber: | 5028671226 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2022 | ||||||||
| LastUpdateDate: | 06/24/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 156FX1800X | 273367 | KY | Y | Eye and Vision Services Providers | Technician/Technologist | Optician |
No ID Information.