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General NPI Number Information
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NPI Number | 1467528174
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Entity Type | Organization
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Legal Business Name | BARRY M. GOOTSON O.D., P.A.
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Dates
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Enumeration Date | 11/27/2006
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Last Update Date | 08/28/2007
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Provider Practice Location Address
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Address Line | 9009 PARK BOULEVARD
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City | SEMINOLE
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State | FL
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Zip | 33777-4152
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Country | US
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Telephone | 727-393-0500
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Fax | 727-397-8930
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Provider Business Mailing Address
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Address Line | 9009 PARK BOULEVARD
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City | SEMINOLE
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State | FL
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Zip | 33777-4152
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Country | US
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Telephone | 727-393-0500
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Fax | 727-397-8930
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BARRY MICHAEL GOOTSON
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Credential | O.D.
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Telephone | 727-393-0500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | FL1085
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License Number State | FL
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