Provider Demographics
NPI:1164947248
Name:GOODE, COURTNEY GRACE (OD)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:GRACE
Last Name:GOODE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3309 FORESTVILLE PL
Practice Address - Street 2:
Practice Address - City:FORESTVILLE
Practice Address - State:MD
Practice Address - Zip Code:20747-4409
Practice Address - Country:US
Practice Address - Phone:301-420-6610
Practice Address - Fax:301-735-0294
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-09
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002906152W00000X
MDTA2623152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist