Provider Demographics
NPI:1942614714
Name:BLOODGOOD, COURTNEY ADELE (OD)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:ADELE
Last Name:BLOODGOOD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:21900 S WEBSTER ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SPRING HILL
Mailing Address - State:KS
Mailing Address - Zip Code:66083-9609
Mailing Address - Country:US
Mailing Address - Phone:913-592-2020
Mailing Address - Fax:913-273-0528
Practice Address - Street 1:21900 S WEBSTER ST
Practice Address - Street 2:SUITE B
Practice Address - City:SPRING HILL
Practice Address - State:KS
Practice Address - Zip Code:66083-9609
Practice Address - Country:US
Practice Address - Phone:913-592-2020
Practice Address - Fax:913-273-0528
Is Sole Proprietor?:No
Enumeration Date:2014-06-19
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1972152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist