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General NPI Number Information
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NPI Number | 1720704869
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Entity Type | Organization
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Legal Business Name | TODD ALAN GOODGLICK, MD, PC
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Dates
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Enumeration Date | 10/19/2022
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Last Update Date | 01/19/2023
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Provider Practice Location Address
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Address Line | 5530 WISCONSIN AVE STE 1209
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City | CHEVY CHASE
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State | MD
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Zip | 20815-4301
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Country | US
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Telephone | 202-412-9895
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Fax |
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Provider Business Mailing Address
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Address Line | 3037 ORDWAY ST NW
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City | WASHINGTON
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State | DC
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Zip | 20008-3255
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TODD GOODGLICK
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Credential | MD
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Telephone | 202-412-9895
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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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 | 207WX0109X
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Taxonomy Name | Neuro-ophthalmology Physician
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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 | 207WX0200X
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Taxonomy Name | Ophthalmic Plastic and Reconstructive Surgery Physician
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License Number |
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License Number State |
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