Provider Demographics
NPI:1467641589
Name:GOOTSON, BARRY M (OD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:M
Last Name:GOOTSON
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 1:9009 PARK BLVD
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 BLVD
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
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL1085152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL19621Medicare PIN