Individual
DR. MICHAEL JAMES MCGOVERN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
624 HAWKINS AVE, SUITE #1, LAKE RONKONKOMA, NY 11779-2324
(631) 588-5100
Mailing address
624 HAWKINS AVE, SUITE 1, LAKE RONKONKOMA, NY 11779-2324
(631) 588-5100
(631) 588-5185
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
OD2344
TN
152W00000X
Optometrist
Primary
TUV5891
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01870373
—
NY
Enumeration date
07/13/2005
Last updated
05/13/2008
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