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General NPI Number Information
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NPI Number | 1558276899
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Entity Type | Organization
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Legal Business Name | DRGOODEYE LLC
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Dates
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Enumeration Date | 08/18/2026
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Last Update Date | 08/18/2026
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Provider Practice Location Address
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Address Line | 12 KANE CT
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City | PAGE
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State | AZ
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Zip | 86040-0826
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Country | US
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Telephone | 719-467-5143
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3030
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City | PAGE
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State | AZ
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Zip | 86040-3030
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Country | US
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Telephone | 719-467-5143
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Fax |
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Authorized Official
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Title or Position | MEDICAL OFFICER
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Name | DR. SIDNEY BRENT GOODWIN
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Credential | OD
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Telephone | 719-467-5143
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 152WL0500X
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Taxonomy Name | Low Vision Rehabilitation Optometrist
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License Number |
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License Number State |
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