Provider Demographics
NPI:1861402588
Name:GAMBLE, NACONDUS G (OPTOMETRIST)
Entity type:Individual
Prefix:DR
First Name:NACONDUS
Middle Name:G
Last Name:GAMBLE
Suffix:
Gender:F
Credentials:OPTOMETRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:345 LINDQUIST RD
Mailing Address - Street 2:BUILDING 71
Mailing Address - City:FORT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31314-5043
Mailing Address - Country:US
Mailing Address - Phone:912-876-1101
Mailing Address - Fax:
Practice Address - Street 1:345 LINDQUIST RD
Practice Address - Street 2:BUILDING 71
Practice Address - City:FORT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31314-5043
Practice Address - Country:US
Practice Address - Phone:912-876-1101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001839152W00000X
SC1474152W00000X
GAOPT2433152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist