Provider Demographics
NPI:1750394888
Name:GOODWIN, CURTIS L (OD)
Entity type:Individual
Prefix:
First Name:CURTIS
Middle Name:L
Last Name:GOODWIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MIFFLIN AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503
Mailing Address - Country:US
Mailing Address - Phone:570-342-3145
Mailing Address - Fax:570-344-1309
Practice Address - Street 1:3168 MEMORIAL HWY
Practice Address - Street 2:SUITE 4
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612-9201
Practice Address - Country:US
Practice Address - Phone:570-675-3627
Practice Address - Fax:570-675-7320
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000561152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
13640OtherGEISINGER
GO096131OtherHIGH MARK BLUE SHIELD
PA000859790Medicaid
078258OtherFIRST PRIORITY HEALTH
410038354OtherRAILROAD MEDICARE
506554OtherAETNA
T28501Medicare UPIN
PA000859790Medicaid