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NPI Code Detail

MEDICARE: ANDREW M GOODMAN OD

MEDICARE: ANDREW M GOODMAN 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
1152W00000XOptometrist0618000165VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1174500631
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREW M GOODMAN OD
Provider Business Mailing Address
First Line : 856 J CLYDE MORRIS BLVD
Second Line : SUITE A
City : NEWPORT NEWS
State : VA
Zip : 23601-1318
Country : US
Telephone Number : 757-594-4006
Fax Number : 757-594-2195
Provider Business Practice Location Address
First Line : 4032 CAMPBELL RD
Second Line : SUITE B
City : NEWPORT NEWS
State : VA
Zip : 23602-4252
Country : US
Telephone Number : 757-877-3956
Fax Number : 757-856-7121
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/27/2005
Last Update Date : 05/10/2011

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