Provider Demographics
NPI:1073503421
Name:GODINES, BRIAN EDWARD (OD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:EDWARD
Last Name:GODINES
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Gender:M
Credentials:OD
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Mailing Address - Street 1:1 BOONE RD
Mailing Address - Street 2:NAVAL HOSPITAL BREMERTON
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-1894
Mailing Address - Country:US
Mailing Address - Phone:360-475-4426
Mailing Address - Fax:360-475-4344
Practice Address - Street 1:1 BOONE RD
Practice Address - Street 2:NAVAL HOSPITAL BREMERTON
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312-1894
Practice Address - Country:US
Practice Address - Phone:360-475-4426
Practice Address - Fax:360-475-4344
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-26
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA12097-T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist