Provider Demographics
NPI:1477858769
Name:GOODWIN, JONATHAN PAUL (OD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:PAUL
Last Name:GOODWIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:22 BERNEY WAY DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-9112
Mailing Address - Country:US
Mailing Address - Phone:870-612-9202
Mailing Address - Fax:
Practice Address - Street 1:9800 BAPTIST HEALTH DR STE 301
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6230
Practice Address - Country:US
Practice Address - Phone:501-225-4488
Practice Address - Fax:870-536-9020
Is Sole Proprietor?:No
Enumeration Date:2011-01-18
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD0000002929152W00000X
AR2668152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist