Provider Demographics
NPI:1184638330
Name:GOODNIGHT, ELIZABETH (OD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:GOODNIGHT
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 1:6175 HARBOUR OVERLOOK
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-6901
Mailing Address - Country:US
Mailing Address - Phone:713-851-1017
Mailing Address - Fax:
Practice Address - Street 1:6175 HARBOUR OVERLOOK
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-6901
Practice Address - Country:US
Practice Address - Phone:713-851-1017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002179152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8D6569Medicare ID - Type Unspecified
TX92957Medicare UPIN