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General NPI Number Information
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NPI Number | 1366870479
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Entity Type | Organization
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Legal Business Name | GOODMAN EYE CLINIC
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Dates
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Enumeration Date | 10/29/2013
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Last Update Date | 10/29/2013
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Provider Practice Location Address
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Address Line | 10513 SILVERDALE WAY NW SUITE 110
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City | SILVERDALE
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State | WA
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Zip | 98383-9499
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Country | US
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Telephone | 360-698-3680
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Fax | 360-692-2963
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Provider Business Mailing Address
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Address Line | 10513 SILVERDALE WAY NW SUITE 110
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City | SILVERDALE
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State | WA
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Zip | 98383-9499
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Country | US
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Telephone | 360-698-3680
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Fax | 360-692-2963
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Authorized Official
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Title or Position | OPTOMOTRIST/ OWNER
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Name | DR. DENNIS W GOODMAN
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Credential | O.D.
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Telephone | 360-698-3680
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1749TX
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License Number State | WA
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