Provider Demographics
NPI:1386782449
Name:GOINS, GREG N
Entity type:Individual
Prefix:MR
First Name:GREG
Middle Name:N
Last Name:GOINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 SUNSET PLZ
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-6532
Mailing Address - Country:US
Mailing Address - Phone:580-233-4700
Mailing Address - Fax:580-233-4700
Practice Address - Street 1:218 SUNSET PLZ
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-6532
Practice Address - Country:US
Practice Address - Phone:580-233-4700
Practice Address - Fax:580-233-4700
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK4943850001Medicare ID - Type Unspecified