Provider Demographics
NPI:1518092303
Name:GOUKLER, ROSS ALAN (OD)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:ALAN
Last Name:GOUKLER
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 1:803 QUAIL WAY
Mailing Address - Street 2:
Mailing Address - City:CHESTER SPRINGS
Mailing Address - State:PA
Mailing Address - Zip Code:19425-2119
Mailing Address - Country:US
Mailing Address - Phone:610-458-4304
Mailing Address - Fax:610-458-4304
Practice Address - Street 1:204 EXTON SQUARE MALL
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2442
Practice Address - Country:US
Practice Address - Phone:610-594-8311
Practice Address - Fax:610-363-8545
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000776152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAGO1354276OtherBLUE CROSS
PA3421218OtherAETNA
PA3421218OtherAETNA
PAGO097648Medicare ID - Type Unspecified