Individual
JENNA LOUISE GONGOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
RT 250 219 CHENOWETH CREEK RD, ELKINS, WV 26241
(304) 636-3887
(304) 636-0538
Mailing address
PO BOX 1489, ELKINS, WV 26241
(304) 636-3887
(304) 636-0538
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
93800
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0149877000
—
WV
Enumeration date
10/04/2006
Last updated
03/09/2010
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