Provider Demographics
NPI:1972610210
Name:GIBBS, ROBERT D (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:D
Last Name:GIBBS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1506
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-0409
Mailing Address - Country:US
Mailing Address - Phone:360-242-3008
Mailing Address - Fax:360-807-7687
Practice Address - Street 1:3900 KERN WAY
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-7803
Practice Address - Country:US
Practice Address - Phone:509-966-1356
Practice Address - Fax:509-966-5101
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00003294152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1023548Medicaid
ID410045007OtherRAIL ROAD MEDICARE
WA410045005OtherRAIL ROAD MEDICARE
MT410047409OtherRAIL ROAD MEDICARE
OR410045008OtherRAIL ROAD MEDICARE
ID410045007OtherRAIL ROAD MEDICARE
WA410045005OtherRAIL ROAD MEDICARE
WAGAB19555Medicare PIN
WAGAB19553Medicare PIN
MT000082441Medicare PIN
WAGAB19554Medicare PIN
WAGAB19551Medicare PIN
ID410045007OtherRAIL ROAD MEDICARE
U05586Medicare UPIN
AKK160054Medicare PIN
WAGAB19552Medicare PIN
ID1592031Medicare PIN