Individual
DR. BEVERLY ANNE GOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
1950 OLD GALLOWS RD, SUITE 520, VIENNA, VA 22182-3990
(703) 847-8899
(703) 991-0514
Mailing address
1950 OLD GALLOWS RD, SUITE 520, VIENNA, VA 22182-3990
(703) 847-8899
(703) 991-0514
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1351
NC
152W00000X
Optometrist
S-680 TA-388
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00343
BLUE CROSS BLUE SHIELD
AL
01
—
09311
BCBS OF NC
NC
05
—
8909311
—
NC
01
—
DE7256
RAILROAD MEDICARE GROUP
NC
Enumeration date
11/28/2006
Last updated
11/05/2014
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