Provider Demographics
NPI:1639175011
Name:GOODMAN, DENNIS W (OD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:W
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:10513 SILVERDALE WAY NW
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-9499
Mailing Address - Country:US
Mailing Address - Phone:360-698-3680
Mailing Address - Fax:360-692-2963
Practice Address - Street 1:10513 SILVERDALE WAY NW
Practice Address - Street 2:SUITE 110
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-9499
Practice Address - Country:US
Practice Address - Phone:360-698-3680
Practice Address - Fax:360-692-2963
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00001749152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2027399Medicaid
WA8856486Medicare PIN
WA2027399Medicaid
WAT02166Medicare UPIN