Basic Information
| Provider Information | |||||||||
| NPI: | 1568569721 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GIBB | ||||||||
| FirstName: | REED | ||||||||
| MiddleName: | THOMAS | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 619 S BLUFF ST | ||||||||
| Address2: | TOWER 1 SUITE 1B | ||||||||
| City: | ST GEORGE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 847703853 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4356524040 | ||||||||
| FaxNumber: | 4356524041 | ||||||||
| Practice Location | |||||||||
| Address1: | 619 S BLUFF ST | ||||||||
| Address2: | TOWER 1 SUITE 1B | ||||||||
| City: | ST GEORGE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 847703853 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4356524040 | ||||||||
| FaxNumber: | 4356524041 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 5346530-9937 | UT | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.