MEDICARE: DR. KEEL M GODWIN 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	1718	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0922E	OTHER	NC	BCBS PIN

General Provider Information

NPI Number	:	1861441834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEEL M GODWIN OD

Provider Business Mailing Address
First Line	:	4109 WAKE FOREST RD STE 10
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27609-2510
Country	:	US
Telephone Number	:	984-213-8863
Fax Number	:

Provider Business Practice Location Address
First Line	:	4109 WAKE FOREST RD STE 10
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27609-2510
Country	:	US
Telephone Number	:	984-213-8863
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	05/10/2022

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Directions to “ DR. KEEL M GODWIN OD” Practice Location

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