Provider Demographics
NPI:1750356754
Name:GOODWIN, LAWRENCE T JR (MD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:T
Last Name:GOODWIN
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:8717 LA TIJERA BLVD
Mailing Address - Street 2:STE. 700
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3906
Mailing Address - Country:US
Mailing Address - Phone:310-645-4393
Mailing Address - Fax:310-645-3344
Practice Address - Street 1:21840 NORMANDIE AVE
Practice Address - Street 2:STE. 700
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2047
Practice Address - Country:US
Practice Address - Phone:310-222-5101
Practice Address - Fax:310-320-5463
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2016-12-21
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Provider Licenses
StateLicense IDTaxonomies
CAC40581207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C405810Medicaid
CA00C405810Medicaid
CAA37402Medicare UPIN
AZWC40521FMedicare PIN