Provider Demographics
NPI:1689822983
Name:GOSS, KIMBERLEY DAWN (OD)
Entity type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:DAWN
Last Name:GOSS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 LEIGHTON RD
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-2207
Mailing Address - Country:US
Mailing Address - Phone:207-797-2990
Mailing Address - Fax:
Practice Address - Street 1:75 LEIGHTON RD
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-2207
Practice Address - Country:US
Practice Address - Phone:207-797-2990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-29
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME899152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0008974Medicare PIN