Provider Demographics
NPI:1629030457
Name:DAVID L GOHMAN OD INC
Entity Type:Organization
Organization Name:DAVID L GOHMAN OD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:712-737-2126
Mailing Address - Street 1:PO BOX 108
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51041
Mailing Address - Country:US
Mailing Address - Phone:712-737-2126
Mailing Address - Fax:712-737-3022
Practice Address - Street 1:110 2ND ST NW
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:IA
Practice Address - Zip Code:51041
Practice Address - Country:US
Practice Address - Phone:712-737-2126
Practice Address - Fax:712-737-3022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01616152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0151035Medicaid
U01939Medicare UPIN
IAI19248Medicare PIN
IA0151035Medicaid