Individual
DR. STEPHANIE R GOGGIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
6620 CENTER GROVE ROAD, EDWARDSVILLE, IL 62025-2802
(618) 659-1900
(618) 659-1901
Mailing address
6620 CENTER GROVE RD, SUITE 3, EDWARDSVILLE, IL 62025-2802
(618) 659-1900
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046-009281
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046009281
—
IL
01
—
410043847
RAILROAD MEDICARE - SFLD
IL
01
—
410043848
RAILROAD MEDICARE - HILLS
IL
Enumeration date
05/05/2006
Last updated
12/08/2011
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