Provider Demographics
NPI:1023113222
Name:GOGOLA, GLORIA BERNADETTE (OD)
Entity type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:BERNADETTE
Last Name:GOGOLA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 FRIENDSHIP WAY
Mailing Address - Street 2:
Mailing Address - City:PARKESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:19365-9171
Mailing Address - Country:US
Mailing Address - Phone:717-442-1300
Mailing Address - Fax:717-442-1064
Practice Address - Street 1:5351 LINCOLN HWY
Practice Address - Street 2:SUITE 2
Practice Address - City:GAP
Practice Address - State:PA
Practice Address - Zip Code:17527-9468
Practice Address - Country:US
Practice Address - Phone:717-442-1300
Practice Address - Fax:717-442-1064
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000541152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPA08206OtherVBA
PA381737OtherHIGHMARK
PA397049OtherNVA
PAEC19251OtherSPECTERA
PA2651259OtherAETNA
PAEC19251OtherSPECTERA
PA2651259OtherAETNA