Provider Demographics
NPI:1013904127
Name:GOEPFERT, LINDA L (OD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:L
Last Name:GOEPFERT
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 1:1831 E CHOCOLATE AVE
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-1124
Mailing Address - Country:US
Mailing Address - Phone:717-533-5990
Mailing Address - Fax:717-533-4072
Practice Address - Street 1:1831 E CHOCOLATE AVE
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-1124
Practice Address - Country:US
Practice Address - Phone:717-533-5990
Practice Address - Fax:717-533-4072
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000402152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOEG000402OtherPA STATE LICENSE
PAT30172Medicare UPIN
0600680001Medicare NSC
PA402799Medicare PIN