Organization
RAYMOND M GOGA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUE BUSHMAN (OFFICE MANAGER)
(715) 253-2157
Entity
Organization
Contact information
Practice address
601 S WEBB ST, WITTENBERG, WI 54499-9042
(715) 253-2157
(715) 253-3457
Mailing address
601 S WEBB ST, WITTENBERG, WI 54499-9042
(715) 253-2157
(715) 253-3457
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1535
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38502100
—
WI
Enumeration date
12/21/2006
Last updated
12/18/2009
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