Healthcare Provider Details

I. General information

NPI: 1639860695
Provider Name (Legal Business Name): DONNA GOUKLER, O.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2023
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

266 DELAWARE AVE
DELMAR NY
12054-1134
US

IV. Provider business mailing address

4183 MACKENZIE CT
MASON OH
45040-4663
US

V. Phone/Fax

Practice location:
  • Phone: 518-439-6309
  • Fax:
Mailing address:
  • Phone: 518-439-6309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. DONNA GOUKLER
Title or Position: OWNER
Credential: O.D.
Phone: 518-439-6309