Provider Demographics
NPI:1497741151
Name:GOEBEL, RICHARD M (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:M
Last Name:GOEBEL
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 1:101 W 84TH AVE
Mailing Address - Street 2:STE 240
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80260-4807
Mailing Address - Country:US
Mailing Address - Phone:303-426-5550
Mailing Address - Fax:303-426-1180
Practice Address - Street 1:101 W 84TH AVE
Practice Address - Street 2:STE 240
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80260-4807
Practice Address - Country:US
Practice Address - Phone:303-426-5550
Practice Address - Fax:303-426-1180
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT 813152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08008138Medicaid
CO388508Medicare ID - Type UnspecifiedGROUP MEDICARE #
CO08008138Medicaid
CO77333Medicare ID - Type Unspecified