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NPI Code Detail

MEDICARE: BARRY M. GOOTSON O.D., P.A.

MEDICARE: BARRY M. GOOTSON O.D., P.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometristFL1085FL

General Provider Information

NPI Number : 1467528174
Entity Type Code : Organization
Provider Name (Legal Business Name) : BARRY M. GOOTSON O.D., P.A.
Provider Business Mailing Address
First Line : 9009 PARK BOULEVARD
Second Line :
City : SEMINOLE
State : FL
Zip : 33777-4152
Country : US
Telephone Number : 727-393-0500
Fax Number : 727-397-8930
Provider Business Practice Location Address
First Line : 9009 PARK BOULEVARD
Second Line :
City : SEMINOLE
State : FL
Zip : 33777-4152
Country : US
Telephone Number : 727-393-0500
Fax Number : 727-397-8930
Authorized Official
Title or Position : PRESIDENT
Name : DR. BARRY MICHAEL GOOTSON
Credential : O.D.
Telephone Number : 727-393-0500
Provider Enumeration Date : 11/27/2006
Last Update Date : 08/28/2007

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