Provider Demographics
NPI:1740215185
Name:GOETZ, LINN (OD)
Entity Type:Individual
Prefix:MRS
First Name:LINN
Middle Name:
Last Name:GOETZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 BUFFALO RD
Mailing Address - Street 2:SUITE 700
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624
Mailing Address - Country:US
Mailing Address - Phone:585-328-0163
Mailing Address - Fax:585-328-0158
Practice Address - Street 1:485 TITUS AVENUE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14617
Practice Address - Country:US
Practice Address - Phone:585-266-7880
Practice Address - Fax:585-266-5177
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005295152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU25116Medicare UPIN