Healthcare Provider Details

I. General information

NPI: 1235478223
Provider Name (Legal Business Name): CASSIE R GOODMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2013
Last Update Date: 02/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2351 ERWIN RD
DURHAM NC
27710-4699
US

IV. Provider business mailing address

7100 SIX FORKS RD SUITE 301
RALEIGH NC
27615-6156
US

V. Phone/Fax

Practice location:
  • Phone: 919-282-0053
  • Fax: 919-282-0057
Mailing address:
  • Phone: 919-847-0187
  • Fax: 919-676-2231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: