Provider Demographics
NPI:1407906415
Name:GOHMAN, DAVID L (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:GOHMAN
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 108
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51041-0108
Mailing Address - Country:US
Mailing Address - Phone:712-737-2126
Mailing Address - Fax:712-737-3022
Practice Address - Street 1:110 2ND ST NW
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:IA
Practice Address - Zip Code:51041-1413
Practice Address - Country:US
Practice Address - Phone:712-737-2126
Practice Address - Fax:712-737-3022
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1616152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0151035Medicaid
IA0151035Medicaid
IAU01939Medicare UPIN