Provider Demographics
NPI:1144223058
Name:GOFF, KATHLEEN E (OD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:E
Last Name:GOFF
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3835
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79923-3835
Mailing Address - Country:US
Mailing Address - Phone:915-544-6700
Mailing Address - Fax:915-544-6707
Practice Address - Street 1:2222 MONTANA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903-3602
Practice Address - Country:US
Practice Address - Phone:915-544-6700
Practice Address - Fax:915-544-6707
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX02539TG152WP0200X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80664QOtherBLUE CROSS BLUE SHIELD
TX037028002Medicaid
TX80664QOtherBLUE CROSS BLUE SHIELD
TXT13481Medicare UPIN
TXP00353832Medicare PIN
TX8B9574Medicare PIN