Gough, Beverly Anne
Gough, Beverly Anne is an individual health care provider with primary practice located at 1950 Old Gallows Rd Suite 520, Vienna VA 22182-3990. She recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as her primary health care specialty. Gough, Beverly Anne can be contacted via phone (703) 847-8899.Contact Information
Primary practice address
1950 Old Gallows Rd Suite 520
Vienna VA 22182-3990
Phone: (703) 847-8899
Fax: (703) 991-0514
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | S-680 TA-388 | Alabama |
| Eye and Vision Services Providers / Optometrist | 152W00000X | 1351 | North Carolina |
Profile Details
| NPI number | 1811063142 |
|---|---|
| LBN Legal business name | Gough, Beverly Anne |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 28th, 2006 |
| Last updated | Nov 5th, 2014 - about 11 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1811063142 | NPPES |
| North Carolina | Other | 09311 | BCBS OF NC |
| North Carolina | Other | DE7256 | BCBS OF NC |
| North Carolina | Other | 00343 | BCBS OF NC |
| North Carolina | MEDICAID | 8909311 | BCBS OF NC |
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