Provider Demographics
NPI:1326026071
Name:GOEDDE, DAWN JENNIFER (OD)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:JENNIFER
Last Name:GOEDDE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:JENNIFER
Other - Last Name:BURGEI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:338 W 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43210-1280
Mailing Address - Country:US
Mailing Address - Phone:614-247-7889
Mailing Address - Fax:614-247-6626
Practice Address - Street 1:338 W 10TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1280
Practice Address - Country:US
Practice Address - Phone:614-247-7889
Practice Address - Fax:614-247-6626
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5462152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHV06767Medicare UPIN