Healthcare Provider Details

I. General information

NPI: 1134910615
Provider Name (Legal Business Name): EMMA GOODWIN OD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2025
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 NW 17TH ST
MIAMI FL
33136-1134
US

IV. Provider business mailing address

240 LINDEN RD
PINEHURST NC
28374-9068
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-2020
  • Fax:
Mailing address:
  • Phone: 919-349-2659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: