Provider Demographics
NPI:1033676119
Name:DR. GEORGE GOODMAN, INC.
Entity Type:Organization
Organization Name:DR. GEORGE GOODMAN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR (OPTOMETRIST)
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:405-245-9333
Mailing Address - Street 1:1431 SKY ROCK WAY
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-3691
Mailing Address - Country:US
Mailing Address - Phone:405-245-9333
Mailing Address - Fax:
Practice Address - Street 1:720 S COLORADO BLVD STE 140A
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-1916
Practice Address - Country:US
Practice Address - Phone:303-607-0174
Practice Address - Fax:303-607-0149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-26
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty