Provider Demographics
NPI:1437146321
Name:GOGINS, HUGH M (OD)
Entity Type:Individual
Prefix:DR
First Name:HUGH
Middle Name:M
Last Name:GOGINS
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 1:4052 OLD GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-2849
Mailing Address - Country:US
Mailing Address - Phone:847-662-7617
Mailing Address - Fax:
Practice Address - Street 1:4052 OLD GRAND AVE
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-2849
Practice Address - Country:US
Practice Address - Phone:847-662-7617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2008-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-006271152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1622617OtherBLUE CROSS BLUE SHIELD
ILK30176Medicare PIN