Provider Demographics
NPI:1689761561
Name:GOUSY, MICHAEL JOHN (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:GOUSY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:120 WESTFIELD ST
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-2508
Mailing Address - Country:US
Mailing Address - Phone:413-733-2318
Mailing Address - Fax:413-732-4824
Practice Address - Street 1:120 WESTFIELD ST
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-2508
Practice Address - Country:US
Practice Address - Phone:413-733-2318
Practice Address - Fax:413-732-4824
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3427152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA24651OtherHEALTH NEW ENGLAND
MA730566OtherCONNCETICARE
MA2110327OtherAETNA
MA0369446Medicaid
MA000000021089OtherBMC HEALTH NET PLAN
MA102459OtherCIGNA
MAW15909OtherBLUE CROSS BLUE SHEILD
MA763475OtherTUFTS HEALTH PLAN
MA152198OtherHARVARD PILGRIM HEALTH PL
MA463258Medicare ID - Type Unspecified
MA152198OtherHARVARD PILGRIM HEALTH PL