=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659791119
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MORGAN ROGERS GODIN M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2014
-----------------------------------------------------
Last Update Date | 11/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 50 BUCK CREEK ROAD #200
-----------------------------------------------------
City | AVON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-926-6340
-----------------------------------------------------
Fax | 970-926-6348
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 4330
-----------------------------------------------------
City | AVON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81620-4330
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-926-6340
-----------------------------------------------------
Fax | 970-926-6348
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | 201215
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | 63378
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | 62480
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------