Healthcare Provider Details

I. General information

NPI: 1730382433
Provider Name (Legal Business Name): PAUL R GOOCH OD & ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 01/30/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

965 EAST 700 SOUTH SUITE #100
ST GEORGE UT
84790-4084
US

IV. Provider business mailing address

965 EAST 700 SOUT SUITE #100
ST GEORGE UT
84790-4084
US

V. Phone/Fax

Practice location:
  • Phone: 435-673-5577
  • Fax: 435-688-0381
Mailing address:
  • Phone: 435-673-5577
  • Fax: 435-688-0381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3464559934
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number56793429934
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number3464559934
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number56793429934
License Number StateUT
# 5
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number3464559934
License Number StateUT
# 6
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number56793429934
License Number StateUT
# 7
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number3464559934
License Number StateUT
# 8
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number56793429934
License Number StateUT
# 9
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number3464559934
License Number StateUT
# 10
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number56793429934
License Number StateUT

VIII. Authorized Official

Name: MRS. JENNA L FOX
Title or Position: BILLING MANAGER
Credential:
Phone: 435-673-5577