Provider Demographics
NPI:1467528174
Name:BARRY M. GOOTSON O.D., P.A.
Entity Type:Organization
Organization Name:BARRY M. GOOTSON O.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GOOTSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:727-393-0500
Mailing Address - Street 1:9009 PARK BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33777-4152
Mailing Address - Country:US
Mailing Address - Phone:727-393-0500
Mailing Address - Fax:727-397-8930
Practice Address - Street 1:9009 PARK BOULEVARD
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33777-4152
Practice Address - Country:US
Practice Address - Phone:727-393-0500
Practice Address - Fax:727-397-8930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL1085152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL19621Medicare PIN