Provider Demographics
NPI:1780919860
Name:GOODMAN, MATT (OD)
Entity type:Individual
Prefix:DR
First Name:MATT
Middle Name:
Last Name:GOODMAN
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 1:401 EXCHANGE BLVD
Mailing Address - Street 2:
Mailing Address - City:HUTTO
Mailing Address - State:TX
Mailing Address - Zip Code:78634-5717
Mailing Address - Country:US
Mailing Address - Phone:512-846-1004
Mailing Address - Fax:
Practice Address - Street 1:401 EXCHANGE BLVD
Practice Address - Street 2:
Practice Address - City:HUTTO
Practice Address - State:TX
Practice Address - Zip Code:78634-5717
Practice Address - Country:US
Practice Address - Phone:512-846-1004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9116152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist