Provider Demographics
NPI:1912124694
Name:GOUINLOCK, ROBERT EMBURY (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EMBURY
Last Name:GOUINLOCK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 HALLS CORNERS RD
Mailing Address - Street 2:
Mailing Address - City:ATTICA
Mailing Address - State:NY
Mailing Address - Zip Code:14011-9335
Mailing Address - Country:US
Mailing Address - Phone:585-591-0903
Mailing Address - Fax:
Practice Address - Street 1:216 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-2221
Practice Address - Country:US
Practice Address - Phone:585-343-0633
Practice Address - Fax:585-343-0211
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTOO5845152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU74916Medicare UPIN
NYU74916Medicare ID - Type Unspecified