Healthcare Provider Details

I. General information

NPI: 1932804101
Provider Name (Legal Business Name): KINSLEY GOSSARD OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 02/12/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 CEI DR
BLUE ASH OH
45242-5664
US

IV. Provider business mailing address

PO BOX 201659
DALLAS TX
75320-1659
US

V. Phone/Fax

Practice location:
  • Phone: 513-984-5133
  • Fax: 513-984-4240
Mailing address:
  • Phone:
  • Fax: 513-984-4240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3223
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT.007256
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: