Provider Demographics
NPI:1972590396
Name:GOFF, MARTHA DAWN (OD)
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:DAWN
Last Name:GOFF
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MARTHA
Other - Middle Name:DAWN
Other - Last Name:MCINTOSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:18 UTAH TRL
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-8911
Mailing Address - Country:US
Mailing Address - Phone:609-953-7554
Mailing Address - Fax:
Practice Address - Street 1:3458 NEELY RD
Practice Address - Street 2:
Practice Address - City:MC GUIRE AFB
Practice Address - State:NJ
Practice Address - Zip Code:08641-5312
Practice Address - Country:US
Practice Address - Phone:609-754-9685
Practice Address - Fax:609-754-9417
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 10141152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist