Provider Demographics
NPI:1043537863
Name:GOUKLER, DONNA BLOCHAVIAK (OD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:BLOCHAVIAK
Last Name:GOUKLER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4183 MACKENZIE COURT
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040
Mailing Address - Country:US
Mailing Address - Phone:678-360-4073
Mailing Address - Fax:678-513-3111
Practice Address - Street 1:4183 MACKENZIE CT
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040
Practice Address - Country:US
Practice Address - Phone:678-360-4073
Practice Address - Fax:678-513-3111
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-04
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOPT6243-THER152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist