Provider Demographics
NPI:1477581080
Name:GOULDING, NIDA (OD)
Entity Type:Individual
Prefix:DR
First Name:NIDA
Middle Name:
Last Name:GOULDING
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:PO BOX 633
Mailing Address - Street 2:
Mailing Address - City:LANGLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98260-0633
Mailing Address - Country:US
Mailing Address - Phone:808-281-9272
Mailing Address - Fax:360-579-0749
Practice Address - Street 1:1100 N MERIDIAN
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-4403
Practice Address - Country:US
Practice Address - Phone:253-848-6400
Practice Address - Fax:360-579-0749
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA4049152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist