Healthcare Provider Details

I. General information

NPI: 1497103774
Provider Name (Legal Business Name): JULIE ALANA GOSSARD O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JULIE ALANA STICKEL

II. Dates (important events)

Enumeration Date: 05/27/2016
Last Update Date: 06/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3360 TREMONT RD SUITE 200
COLUMBUS OH
43221-2111
US

IV. Provider business mailing address

3360 TREMONT RD SUITE 200
COLUMBUS OH
43221-2111
US

V. Phone/Fax

Practice location:
  • Phone: 614-486-5205
  • Fax: 614-486-0354
Mailing address:
  • Phone: 614-486-5205
  • Fax: 614-486-0354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number6456
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: