Healthcare Provider Details

I. General information

NPI: 1558276899
Provider Name (Legal Business Name): DRGOODEYE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 KANE CT
PAGE AZ
86040-0826
US

IV. Provider business mailing address

PO BOX 3030
PAGE AZ
86040-3030
US

V. Phone/Fax

Practice location:
  • Phone: 719-467-5143
  • Fax:
Mailing address:
  • Phone: 719-467-5143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. SIDNEY BRENT GOODWIN
Title or Position: MEDICAL OFFICER
Credential: OD
Phone: 719-467-5143