Provider Demographics
NPI:1134368517
Name:GOKMEN FOWLER, FUSUN OZLEN (MD)
Entity type:Individual
Prefix:
First Name:FUSUN
Middle Name:OZLEN
Last Name:GOKMEN FOWLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:FUSUN
Other - Middle Name:OZLEN
Other - Last Name:GOKMEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:51 STATE RD
Mailing Address - Street 2:
Mailing Address - City:DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-3319
Mailing Address - Country:US
Mailing Address - Phone:508-994-1400
Mailing Address - Fax:508-910-2212
Practice Address - Street 1:8120 TIMBERLAKE WAY STE 211
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-5414
Practice Address - Country:US
Practice Address - Phone:916-423-2134
Practice Address - Fax:916-423-4477
Is Sole Proprietor?:No
Enumeration Date:2009-02-09
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA255052207W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110096748AMedicaid
MA003278001Medicare PIN