Provider Demographics
NPI:1588612618
Name:GOINS, MICHAEL EDGAR (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:EDGAR
Last Name:GOINS
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 1:5030 RANDALL PKWY
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-2829
Mailing Address - Country:US
Mailing Address - Phone:910-392-0270
Mailing Address - Fax:910-392-0271
Practice Address - Street 1:5030 RANDALL PKWY
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2829
Practice Address - Country:US
Practice Address - Phone:910-392-0270
Practice Address - Fax:910-392-0271
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1047152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909330Medicaid
NCT64967Medicare UPIN
NC246435Medicare ID - Type Unspecified