Provider Demographics
NPI:1558696203
Name:GOUIN, ROBIN D (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:D
Last Name:GOUIN
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 1:8630 164TH AVE NE STE 100
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3606
Mailing Address - Country:US
Mailing Address - Phone:425-885-7363
Mailing Address - Fax:425-861-5585
Practice Address - Street 1:8630 164TH AVE NE
Practice Address - Street 2:SUITE 100
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3606
Practice Address - Country:US
Practice Address - Phone:425-885-7363
Practice Address - Fax:425-861-5585
Is Sole Proprietor?:No
Enumeration Date:2009-10-14
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD60100047152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1558696203Medicaid
WAG8901343Medicare PIN
WAG8893836Medicare PIN