MEDICARE: ROBERT N. GOODHEAD, 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
1	152W00000X	Optometrist	759	OK

General Provider Information

NPI Number	:	1801223953
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT N. GOODHEAD, OD

Provider Business Mailing Address
First Line	:	6401 NW EXPRESSWAY
Second Line	:	SUITE 130
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73132-5170
Country	:	US
Telephone Number	:	405-721-8500
Fax Number	:	405-721-9260

Provider Business Practice Location Address
First Line	:	6401 NW EXPRESSWAY
Second Line	:	SUITE 130
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73132-5170
Country	:	US
Telephone Number	:	405-721-8500
Fax Number	:	405-721-9260

Authorized Official
Title or Position	:	OWNER / SOLE PROPRIETOR
Name	:	DR. ROBERT NEW GOODHEAD
Credential	:	OD
Telephone Number	:	405-721-8500

Provider Enumeration Date	:	10/03/2013
Last Update Date	:	10/03/2013

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