Provider Demographics
NPI:1275169088
Name:GOODMAN, MAHALIA LEONTINE (EYE SPECIALIST)
Entity Type:Individual
Prefix:
First Name:MAHALIA
Middle Name:LEONTINE
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:EYE SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 ANDREWS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT RUCKER
Mailing Address - State:AL
Mailing Address - Zip Code:36362
Mailing Address - Country:US
Mailing Address - Phone:800-261-7193
Mailing Address - Fax:334-255-7710
Practice Address - Street 1:301 ANDREWS AVE
Practice Address - Street 2:
Practice Address - City:FORT RUCKER
Practice Address - State:AL
Practice Address - Zip Code:36362
Practice Address - Country:US
Practice Address - Phone:800-261-7193
Practice Address - Fax:334-255-7710
Is Sole Proprietor?:No
Enumeration Date:2020-03-13
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1202XEye and Vision Services ProvidersTechnician/TechnologistOptometric Technician