Basic Information
| Provider Information | |||||||||
| NPI: | 1659785178 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GIBBERMAN | ||||||||
| FirstName: | ALEX | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8211 CORNELL RD | ||||||||
| Address2: | SUITE 510 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452492273 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135300440 | ||||||||
| FaxNumber: | 5135300473 | ||||||||
| Practice Location | |||||||||
| Address1: | 8211 CORNELL RD | ||||||||
| Address2: | SUITE 510 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452492273 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135300440 | ||||||||
| FaxNumber: | 5135300473 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2014 | ||||||||
| LastUpdateDate: | 06/12/2014 | ||||||||
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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 | 6280 T3196 | OH | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.