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General NPI Number Information
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NPI Number | 1811095680
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Entity Type | Organization
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Legal Business Name | GOODRICH OPTICAL INC
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 10/01/2019
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Provider Practice Location Address
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Address Line | 6425 S PENNSYLVANIA AVE STE 13
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City | LANSING
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State | MI
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Zip | 48911-5975
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Country | US
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Telephone | 517-393-2660
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Fax | 517-393-1313
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Provider Business Mailing Address
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Address Line | 2450 DELHI COMMERCE DR STE 1
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City | HOLT
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State | MI
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Zip | 48842-2193
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Country | US
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Telephone | 517-393-2660
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Fax | 517-393-1313
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Authorized Official
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Title or Position | CIO
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Name | MR. DAVID S GOODRICH
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Credential | ABOM
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Telephone | 517-393-2660
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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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