Provider Demographics
NPI:1689816753
Name:GOGA, ERIN LEIGH (OD)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:LEIGH
Last Name:GOGA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:515 N 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-2910
Mailing Address - Country:US
Mailing Address - Phone:715-848-1246
Mailing Address - Fax:715-842-1660
Practice Address - Street 1:515 N 17TH AVE
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-2910
Practice Address - Country:US
Practice Address - Phone:715-848-1246
Practice Address - Fax:715-842-1660
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-03
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3094-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist