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NPI Code Detail

MEDICARE: DR. NIDA GOULDING O.D.

MEDICARE: DR. NIDA GOULDING O.D.
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
1152W00000XOptometrist4049WA

General Provider Information

NPI Number : 1477581080
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NIDA GOULDING O.D.
Provider Business Mailing Address
First Line : PO BOX 633
Second Line :
City : LANGLEY
State : WA
Zip : 98260-0633
Country : US
Telephone Number : 808-281-9272
Fax Number : 360-579-0749
Provider Business Practice Location Address
First Line : 1100 N MERIDIAN
Second Line :
City : PUYALLUP
State : WA
Zip : 98371-4403
Country : US
Telephone Number : 253-848-6400
Fax Number : 360-579-0749
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2006
Last Update Date : 12/20/2010

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