Provider Demographics
NPI:1801223953
Name:ROBERT N. GOODHEAD, OD
Entity Type:Organization
Organization Name:ROBERT N. GOODHEAD, OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:NEW
Authorized Official - Last Name:GOODHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:405-721-8500
Mailing Address - Street 1:6401 NW EXPRESSWAY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-5170
Mailing Address - Country:US
Mailing Address - Phone:405-721-8500
Mailing Address - Fax:405-721-9260
Practice Address - Street 1:6401 NW EXPRESSWAY
Practice Address - Street 2:SUITE 130
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73132-5170
Practice Address - Country:US
Practice Address - Phone:405-721-8500
Practice Address - Fax:405-721-9260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK759152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty