Individual provider Active NPI

Dennis W Goodman, O.D.

  • Optometrist
  • Silverdale, WA
National Provider Identifier
1639175011
Registry record updated Nov 19, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OD00001749 Issued in WA
Practice address
10513 Silverdale Way NW
Suite 110
Silverdale, WA 98383-9499
Phone
(360) 698-3680
Fax
(360) 692-2963
NPI assigned
Jun 22, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 19, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OD00001749 WA Primary

Addresses

Primary practice location

10513 Silverdale Way NW
Suite 110
Silverdale, WA 98383-9499

Mailing address

10513 Silverdale Way NW
Suite 110
Silverdale, WA 98383-9499
Phone (360) 698-3680

Other identifiers 1

IdentifierTypeStateIssuer
2027399MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040416000432 WA Practitioner - Optometry 8426043795 Practice locations: Silverdale, WA

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pacific University - College of Optometry, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

10513 Silverdale Way NW
Suite 108
Silverdale, WA 98383-9499
Phone (360) 698-3680

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OD00001749WAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
MC Kinney Whitemarsh PLLC Optometrist Past Accepting new patients
Goodman Eye Clinic Optometrist PastSince Jan 1, 1990 Accepting new patients
MC Kinney Whitemarsh PLLC Optometrist Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1119398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1195430400000",
    "number": "1639175011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10513 SILVERDALE WAY NW",
            "address_2": "SUITE 110",
            "city": "SILVERDALE",
            "state": "WA",
            "postal_code": "983839499",
            "telephone_number": "360-698-3680",
            "fax_number": "360-692-2963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10513 SILVERDALE WAY NW",
            "address_2": "SUITE 110",
            "city": "SILVERDALE",
            "state": "WA",
            "postal_code": "983839499",
            "telephone_number": "360-698-3680",
            "fax_number": "360-692-2963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOODMAN",
        "first_name": "DENNIS",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-22",
        "last_updated": "2007-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD00001749",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2027399",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Silverdale, WA

Sources for this page

Verify at the official NPI Registry.