| |
317 Main St, Gooding, ID 83330-1302 | |
(208) 934-4856 | |
(208) 934-5818 |
Full Name | |
---|---|
Type | Facility |
Speciality | Optometrist |
Location | 317 Main St, Gooding, Idaho |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1619000940 | NPI | - | NPPES |
DA2306 | Other | ID | RAILROAD MEDICARE |
4776340001 | Other | ID | DMERC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | ODP-100008 (Idaho) | Primary |
Provider Name | Raymond Clyde Goodman |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1407859739 PECOS PAC ID: 3274563382 Enrollment ID: I20100819000732 |
Mailing Address | Practice Location Address |
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317 Main St, Gooding, ID 83330-1302 Ph: (208) 934-4856 | 317 Main St, Gooding, ID 83330-1302 Ph: (208) 934-4856 |
Dr. Raymond C. Goodman, O.D. Optometrist Medicare: Accepting Medicare Assignments Practice Location: 317 Main St, Gooding, ID 83330 Phone: 208-934-4856 Fax: 208-934-5818 |