Provider Demographics
NPI:1639571557
Name:KIMBERLEY D GOSS OD PA
Entity Type:Organization
Organization Name:KIMBERLEY D GOSS OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OD
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:GOSS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:207-797-2990
Mailing Address - Street 1:75 LEIGHTON RD
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-2207
Mailing Address - Country:US
Mailing Address - Phone:207-797-2990
Mailing Address - Fax:207-797-0990
Practice Address - Street 1:75 LEIGHTON RD
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-2207
Practice Address - Country:US
Practice Address - Phone:207-797-2990
Practice Address - Fax:207-797-0990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty