Individual
DONALD J GOSSOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
7635 SHELBYVILLE RD, LOUISVILLE, KY 40222-5409
(502) 423-8500
(502) 339-0571
Mailing address
7635 SHELBYVILLE RD, LOUISVILLE, KY 40222-5409
(502) 423-8500
Taxonomy
Speciality
Code
Description
License number
State
152WC0802X
Corneal and Contact Management Optometrist
Primary
1364DT
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000047535
ANTHEM BCBS
KY
01
—
5420222
AETNA
—
05
—
77013647
—
KY
Enumeration date
02/14/2006
Last updated
01/21/2019
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