Provider Demographics
NPI:1275727570
Name:GOODWIN, RICHARD (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:GOODWIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOULTON
Mailing Address - State:ME
Mailing Address - Zip Code:04730-2122
Mailing Address - Country:US
Mailing Address - Phone:207-532-2486
Mailing Address - Fax:207-532-9242
Practice Address - Street 1:75 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOULTON
Practice Address - State:ME
Practice Address - Zip Code:04730-2122
Practice Address - Country:US
Practice Address - Phone:207-532-2486
Practice Address - Fax:207-532-9242
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME611T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
5676080001OtherMEDICARE DME