Provider Demographics
NPI:1407968472
Name:GOODWIN, LYNN E (OD)
Entity Type:Individual
Prefix:MR
First Name:LYNN
Middle Name:E
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:PO BOX 6006
Mailing Address - Street 2:
Mailing Address - City:MYRTLE CREEK
Mailing Address - State:OR
Mailing Address - Zip Code:97457
Mailing Address - Country:US
Mailing Address - Phone:541-863-5258
Mailing Address - Fax:541-863-6000
Practice Address - Street 1:425 N MAIN
Practice Address - Street 2:
Practice Address - City:MYRTLE CREEK
Practice Address - State:OR
Practice Address - Zip Code:97457
Practice Address - Country:US
Practice Address - Phone:541-863-5258
Practice Address - Fax:541-863-6000
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1481ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR226175Medicaid
OR226175Medicaid
0000PHFPGMedicare ID - Type Unspecified
OR0707170001Medicare NSC