Provider Demographics
NPI:1174923403
Name:GOSNELL, PHERRAHJAE C (OD)
Entity type:Individual
Prefix:DR
First Name:PHERRAHJAE
Middle Name:C
Last Name:GOSNELL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4949 BORGEN BLVD
Mailing Address - Street 2:STE 107
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-7895
Mailing Address - Country:US
Mailing Address - Phone:253-313-5652
Mailing Address - Fax:
Practice Address - Street 1:1314 72ND ST E
Practice Address - Street 2:SUITE D
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98404-3343
Practice Address - Country:US
Practice Address - Phone:253-531-5535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-22
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60471254152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist