Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207W00000X | Ophthalmologist | 01069548A | IN |
N | 207W00000X | Ophthalmologist | 11013262A | IN |
Y | 207W00000X | Ophthalmologist | 35120369 | OH |
N | 207W00000X | Ophthalmologist | TP 754 | KY |
NPI | 1003078726 |
---|---|
Provider Name | Robert Joseph Goulet III |
First Address | Blue Ash, OH 45242-5664 |
Second Address | Blue Ash, OH 45242-5664 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2008 |
Last Update Date | 26/11/2012 |