Healthcare Provider Details

I. General information

NPI: 1487573184
Provider Name (Legal Business Name): SOPHIA GODIN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11921 ROCKVILLE PIKE STE 110
ROCKVILLE MD
20852-2744
US

IV. Provider business mailing address

11921 ROCKVILLE PIKE STE 110
ROCKVILLE MD
20852-2744
US

V. Phone/Fax

Practice location:
  • Phone: 301-984-3937
  • Fax:
Mailing address:
  • Phone: 301-984-3937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTA3160
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: