Jeffrey Adam Gibeault, LICENSED OPTICIAN
Individual provider Active NPI Optician · Valatie, NY
NPI 1629659909 · NPPES record last updated Apr 18, 2021
Key facts
- NPI
- 1629659909
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optician 156FX1800X
- License
- 008095-1 (NY)
- Practice address
- 12 Birch Rd
Valatie, NY 12184-4803 - Phone
- (518) 364-3242
- NPI assigned
- Apr 18, 2021
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 008095-1 | NY | MD | Optician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optician | 156FX1800X | 008095-1 | NY | Yes |
Addresses
Primary practice location
12 Birch Rd
Valatie, NY 12184-4803
Mailing address
12 Birch Rd
Valatie, NY 12184-4803
Phone (518) 364-3242
Other providers in Valatie, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 18, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.