Provider Demographics
NPI:1801844378
Name:GOUGER, CAROL ANN (OD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:GOUGER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 MUELLER RD
Mailing Address - Street 2:
Mailing Address - City:WARMINSTER
Mailing Address - State:PA
Mailing Address - Zip Code:18974-2775
Mailing Address - Country:US
Mailing Address - Phone:215-443-9073
Mailing Address - Fax:
Practice Address - Street 1:550A WEST STREET RD
Practice Address - Street 2:
Practice Address - City:WARMINSTER
Practice Address - State:PA
Practice Address - Zip Code:18974-2775
Practice Address - Country:US
Practice Address - Phone:215-443-7706
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0EG000968152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0004402129OtherAETNA
PA01617909Medicaid
PA597042OtherBLUE CROSS BLUE SHIELD
PA0004402129OtherAETNA
U02150Medicare UPIN