Provider Demographics
NPI:1497809388
Name:RICHARD L GOODWIN O.D.,P.C.
Entity Type:Organization
Organization Name:RICHARD L GOODWIN O.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:207-532-2486
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME611T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME117730099Medicaid
ME023153OtherBLUE CROSS
ME5676080001Medicare NSC
MEME0631Medicare PIN
ME023153OtherBLUE CROSS