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General NPI Number Information
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NPI Number | 1518060482
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Entity Type | Individual
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Provider Name | GEORGIETTA R GDOVIN OD
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Gender | Female
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Dates
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Enumeration Date | 09/06/2006
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Last Update Date | 08/22/2018
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Provider Practice Location Address
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Address Line | 101 MONTGOMERY MALL
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City | NORTH WALES
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State | PA
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Zip | 19454
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Country | US
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Telephone | 215-361-2400
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Fax | 215-361-0917
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Provider Business Mailing Address
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Address Line | 101 MONTGOMERY MALL
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City | NORTH WALES
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State | PA
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Zip | 19454-3903
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Country | US
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Telephone | 215-361-2400
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Fax | 215-361-0917
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | OEG000359
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License Number State | PA
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