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NPI Code Detail

MEDICARE: DR. COURTNEY GRACE GOODE OD

MEDICARE: DR. COURTNEY GRACE GOODE OD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist0618002906VA
2152W00000XOptometristTA2623MD

General Provider Information

NPI Number : 1164947248
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. COURTNEY GRACE GOODE OD
Provider Business Mailing Address
First Line : 8614 WESTWOOD CENTER DR FL 9
Second Line :
City : VIENNA
State : VA
Zip : 22182-2442
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3309 FORESTVILLE PL
Second Line :
City : FORESTVILLE
State : MD
Zip : 20747-4409
Country : US
Telephone Number : 301-420-6610
Fax Number : 301-735-0294
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2017
Last Update Date : 06/19/2023

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Directions to “ DR. COURTNEY GRACE GOODE OD” Practice Location

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