Provider Demographics
NPI:1952335580
Name:GDOVIN, DEBORAH M (OD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:M
Last Name:GDOVIN
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 1:390 ROUTE 315 HWY
Mailing Address - Street 2:
Mailing Address - City:PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18640-3903
Mailing Address - Country:US
Mailing Address - Phone:570-883-9696
Mailing Address - Fax:570-654-3739
Practice Address - Street 1:390 ROUTE 315 HWY
Practice Address - Street 2:
Practice Address - City:PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18640-3903
Practice Address - Country:US
Practice Address - Phone:570-883-9696
Practice Address - Fax:570-654-3739
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001392152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist