Provider Demographics
NPI:1457498305
Name:GOOCH, PAUL R (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:R
Last Name:GOOCH
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:965 EAST 700 SOUTH
Mailing Address - Street 2:SUITE #100
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-4084
Mailing Address - Country:US
Mailing Address - Phone:435-673-5577
Mailing Address - Fax:435-688-0381
Practice Address - Street 1:965 EAST 700 SOUTH
Practice Address - Street 2:SUITE #100
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-4084
Practice Address - Country:US
Practice Address - Phone:435-673-5577
Practice Address - Fax:438-688-0381
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT346455-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT87-0575413OtherEIN NUMBER
UT87-0575413OtherEIN NUMBER
UTU69391Medicare UPIN
UT1235160001Medicare NSC