Philllip Goodman

Primary specialty

OpticianTaxonomy code 156FX1800X

License

010346 Issued in NY

Practice address

204 Main Street Shop Ctr
Waterloo, NY 13165-1454

Phone

(315) 539-1209

NPI assigned

Jan 22, 2021

Last updated

Jan 22, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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

• Waterloo Ophthalmic Dispensing, PC

  dba Waterloo Eye Care

  • Eyewear Supplier
  • Waterloo, NY
  • NPI 1518199371
  NPD

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

{
    "created_epoch": "1611273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611273600000",
    "number": "1760072896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 MAIN STREET SHOP CENTRE",
            "city": "WATERLOO",
            "state": "NY",
            "postal_code": "13165",
            "telephone_number": "315-329-1904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 MAIN STREET SHOP CTR",
            "city": "WATERLOO",
            "state": "NY",
            "postal_code": "131651454",
            "telephone_number": "315-539-1209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOODMAN",
        "first_name": "PHILLLIP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-01-22",
        "last_updated": "2021-01-22",
        "certification_date": "2021-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "NY",
            "license": "010346",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Corinne Denise Gere, LCSW
• John J Gobe, OTR
• Cassie Lyn Goldthwait, LAC LMT
• Jennifer Marie Goodison, CTRS
• Daniel Goodman, OPTICIAN
• Mary P Grace, LCSW, CASAC, CPP
• Steven Gray, R.PH.
• Sue A Green, FNP
• Nancy C Griffee, DMD
• Amy Guarino

• Optician in Waterloo, NY
• Providers in Waterloo, NY by specialty
• Optician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.