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General NPI Number Information
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NPI Number | 1780830422
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Entity Type | Organization
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Legal Business Name | GARY E GOBERVILLE OD PA
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Dates
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Enumeration Date | 08/13/2008
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Last Update Date | 08/13/2008
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Provider Practice Location Address
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Address Line | 2344 N UNIVERSITY DR
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City | CORAL SPRINGS
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State | FL
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Zip | 33065-5122
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Country | US
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Telephone | 954-344-3937
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Fax | 954-344-2434
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Provider Business Mailing Address
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Address Line | 2920 NE 47TH ST
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City | LIGHTHOUSE POINT
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State | FL
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Zip | 33064-7136
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Country | US
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Telephone | 954-783-0721
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST OWNER
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Name | DR. GARY E GOBERVILLE
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Credential | OD
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Telephone | 954-344-3937
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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 | OPC2575
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License Number State | FL
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