Provider Demographics
NPI:1083346126
Name:BIBB, DONALD WILLIAM (OPTICIAN)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:WILLIAM
Last Name:BIBB
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8214 PANDOREA DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40258-2048
Mailing Address - Country:US
Mailing Address - Phone:502-552-7345
Mailing Address - Fax:502-231-7054
Practice Address - Street 1:7101 CEDAR SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291-2587
Practice Address - Country:US
Practice Address - Phone:502-231-7753
Practice Address - Fax:502-231-7054
Is Sole Proprietor?:No
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY111898156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician