Provider Demographics
NPI:1568661924
Name:GOOD, ADAM DALE (OD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:DALE
Last Name:GOOD
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 1:2715 W COURT ST
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-3911
Mailing Address - Country:US
Mailing Address - Phone:509-547-8409
Mailing Address - Fax:509-544-7875
Practice Address - Street 1:1906 N 20TH AVE
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-3393
Practice Address - Country:US
Practice Address - Phone:509-547-8409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00004156152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2033553Medicaid
WAP00425944OtherRAILROAD MEDICARE
WA0223113OtherDEPT OF LABOR & INDUSTRY
WA0223113OtherDEPT OF LABOR & INDUSTRY