Provider Demographics
NPI:1497103774
Name:GOSSARD, JULIE ALANA (OD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:ALANA
Last Name:GOSSARD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ALANA
Other - Last Name:STICKEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3360 TREMONT RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-2111
Mailing Address - Country:US
Mailing Address - Phone:614-486-5205
Mailing Address - Fax:614-486-0354
Practice Address - Street 1:3360 TREMONT RD
Practice Address - Street 2:SUITE 200
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-2111
Practice Address - Country:US
Practice Address - Phone:614-486-5205
Practice Address - Fax:614-486-0354
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-27
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6456152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist