MEDICARE: CAROL ANN GOUGER OD

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
1	152W00000X	Optometrist	0EG000968	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0004402129	OTHER	PA	AETNA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	597042	OTHER	PA	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1801844378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL ANN GOUGER OD

Provider Business Mailing Address
First Line	:	1017 MUELLER RD
Second Line	:
City	:	WARMINSTER
State	:	PA
Zip	:	18974-2775
Country	:	US
Telephone Number	:	215-443-9073
Fax Number	:

Provider Business Practice Location Address
First Line	:	550A WEST STREET RD
Second Line	:
City	:	WARMINSTER
State	:	PA
Zip	:	18974-2775
Country	:	US
Telephone Number	:	215-443-7706
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	07/08/2007

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Directions to “ CAROL ANN GOUGER OD” Practice Location

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